Parenting skills and support
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Family-focused support
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Relationship issues
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Trauma/abuse support
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Educational/vocational services
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Legal services
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Sexuality and sexual orientation issues
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Eating disorder support
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Women-only support groups
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Empowerment--that is, holistic programming that emphasizes the development of a
partnership with a female service provider, one in which there are mutual respect and
many opportunities for positive role modeling
Transportation services
Child care, both onsite and supervised
Woman-sensitive women working with women
Long-term case management services that extend to the client and her family
A woman's identity as caregiver/caretaker must be recognized as an extremely powerful factor in
how she accesses care and treatment and how successful she is in her recovery and health
maintenance. There is no question that this identity/role can explain why a woman seeks
treatment ("for the kids") or why she leaves treatment ("to get home to my
husband/partner/kids"). This is also a factor in a woman's sense of guilt and shame from
becoming HIV infected--a societal stigma that only "bad girls" get HIV or are addicts or
alcoholics, and the stigma of being an unfit mother if she has lost custody of her children.
Providers must be open and prepared to discuss safer sex and drug and alcohol abuse from a risk-
reduction perspective. They must be well informed about and comfortable in discussing
sexuality. Risk reduction is an ongoing type of intervention that goes beyond assertiveness
training and teaching women how to put condoms on men. It recognizes the need to "start where
the client is" and use appropriate interventions, which may help a woman reduce her risk of
getting reinfected or of infecting a partner. This includes instructing female injection drug users
about how to use bleach to "clean their works," how to use a female condom, or how to use a
vaginal spermicide foam (not the safest risk-reduction method, however) to lower their risk of
HIV infection when having intercourse. It also involves making referrals to substance abuse
treatment and instruction for male partners on how to use a condom correctly.
Reproductive decisionmaking
Reproductive decisionmaking is an important area for providers to examine with both female and
male clients. Providers must be prepared to discuss pregnancy and family planning with respect
and without judgment. This is a difficult task for providers and clients; counselors may have
many judgments about "right" and "wrong" and many opportunities for countertransference. One
way providers can interact with clients is to help them openly and honestly consider various
factors when making reproductive decisions. Figure 7-6 is adapted from an article written by
Rebecca Dennison, director of a women's health advocacy organization based in San Francisco,
who is HIV positive and considered these issues with her husband in her own reproductive
