Linking Sexual Reproductive Health and HIV PMTCT Simple

Linking Sexual & Reproductive Health and HIV PMTCT: Simple and Complex ICW, Baylor, IPPF New members IATT - 2007 Satellite Session, International AIDS Conference, Mexico City, 5 August 2008 Lynn Collins, Technical Advisor, UNFPA 1

Comprehensive PMTCT 1) Primary prevention of HIV among women of childbearing age 2) Preventing unintended pregnancies among women living with HIV 3) Preventing HIV transmission from a woman living with HIV to her infant 4) Providing treatment, care and support to mothers living with HIV, their children and families 2

Guidance on Global Scale-Up Operationalize links between PMTCT and SRH (pg. 21 -22) ● Deliver comprehensive package of PMTCT services through SRH/STI/VCT ● Increase the availability and quality of SRH programmes ● Integrate HIV counselling & testing into SRH ● Provide high quality SRH to women living with HIV ● Integrate SRH into ART centres or strengthen referral ● Provide FP counselling and education during ANC in all PMTCT settings ● Provide FP counselling and methods during PP in all PMTCT settings ● Develop appropriate guidelines, tools & competencies for SRH PLHIV in the context of PMTCT

Primary prevention of HIV among women of childbearing age – Simple! • Increase awareness of PMTCT & pregnancy/BF as time of risk/vulnerability • STI management (e. g. ANC syphilis) • Safer sex counselling • Condoms with negotiation skills • Treatment of anemia • Viral load/ ‘+ prevention’ • Engagement of men (MNC/FP) • Empowerment of women • Blood safety/universal precautions 4

Primary prevention of HIV among women of childbearing age – Complex! • Delineating the scope/accountability • Weak couples involvement • Insufficient post-test counselling • Low risk/vulnerability perception • Difficulties with behaviour change • PP/ANC/FP not advocating dual protection from condoms • Failure to do ‘positive prevention’ • Gender inequality, GBV stigma and discrimination 5

Preventing unintended pregnancies among women living with HIV – Simple! • Awareness of rights • Counselling (rights, fertility intentions, preventing vertical transmission, etc. ) • Provision of contraceptives (if desired) • Infertility services 6

Preventing unintended pregnancies among women living with HIV – Complex! If it is not measured it doesn’t happen! • Acceptance of FP indicator in PMCT • Linking FP with other services (e. g. ANC, PP, ARV delivery, VCT, etc. ) • Health providers’/others’ attitudes and knowledge of rights and SRH of PLHIV • Package of rights-based FP for PLHIV not widely available 7

Providing treatment, care and support to mothers living with HIV, their children and families – Joint Responsibility! Rights and sexual and reproductive health (SRH) of people living with HIV is a joint responsibility of SRH and HIV programmes • ‘Verticalization’ has created lack of accountability to support the rights and address the SRH/HIV concerns of PLHIV • Multiple entry points but poorly linked • Experience with bi-directional linkages exists 8

Key Messages ● HIV prevention is doable in the context of current PMTCT programmes but not given sufficient priority ● Supporting a rights-based family planning indicator in the context of PMTCT will increase recognition of its importance in PMTCT ● The rights and sexual and reproductive health of people living with HIV is a backbone of PMTCT and must be the joint coordinated responsibility of HIV and SRH programmes, including linking family planning with other services

Prongs 1 & 2 Entry Points Annex 4 Guidance on Global Scale-Up Priority Entry Points ● ANC ● PP ● MNC Additional Entry Points ● Child immunization ● GBV ● Youth-friendly ● Community-based outreach ● FP ● Prevention & treatment for drug users ● HIV care and treatment ● Support groups PLHIV ● STI ● VCT ● TB ● Well-baby follow-up ● Post-abortion care ● Workplace

Annex 4: Guidance on Global Scale-Up ‘Prongs’ 1 & 2 Key Areas Interventions ●Involve male partners in MNC/FP Information and counselling to reduce the risk of sexual transmission ●Increase awareness of the risk of vertical transmission ●Raise awareness of increased HIV risk for pregnant and PP women ●Promote PITC HIV testing and counselling ●Include counselling on PMTCT and FP in HIV counselling ●Support couple counselling, partner testing, and safe/voluntary disclosure Promote male and female condoms ●Promote condom use including during pregnancy and breastfeeding ●Offer guidance on condom negotiation ●Increase availability of contraception in FP including condoms

Annex 4: Guidance on Global Scale-Up ‘Prongs’ 1 & 2 Key Areas Family Planning (FP) Managing sexually transmitted infections (STIs) Gender-based violence (GBV) Interventions ●Promote PITC in FP, linked with counselling on reproductive choices and PMTCT ●Provide FP counselling and contraceptives through HIV care and treatment, VCT, ANC/PP services ●Intensify antenatal screening and treatment of STIs, including syphilis ●Target high-risk groups with prevention and treatment services for STIs ●Provide comprehensive management and support for victims of GBV ●Involve men in reducing GBV

Annex 4: Guidance on Global Scale-Up ‘Prongs’ 1 & 2 Key Areas Blood safety Interventions ●Provide iron and folate supplementation, malaria prophylaxis, and deworming as appropriate to reduce the need for deliveryrelated blood transfusions ●Manage labour as appropriate to reduce the need for delivery-related blood transfusions ●Ensure blood safety ●Promote and implement universal precautions HIV-related stigma and discrimination ●Address health provider stigma and discrimination of PLHIV and vulnerable groups ●Respect clients’ rights to confidentiality, privacy, informed consent, decision-making and equitable care regardless of HIV status