1. Community Contributions to the Four Prongs of PMTCT Dr. Akinyele Eric Dairo, Senior Programme Adviser, UNFPA, Africa Regional Office 06 December 2011 OWN, SCALE-UP & SUSTAIN The 16 th International Conference on AIDS & STIs in Africa 4 to 8 December 2011, Addis Ababa www.icasa2011addis.org

2. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Outline What is a community? Does Community Involvement work? What are the Challenges? Why do we need Community Involvement? What are the four Prongs of PMTCT? Why linkage of SRH and HIV is an Opportunity? Tools How do we Involve Communities?

3. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Why do we need Community Involvement? Putting in the center of their Health Individual and mutual responsibility Dwindling resources and the need to be more cost-effective Enhances acceptance, utilisation Sustainability More reduction of HIV infection Better compliance with treatment and care

4. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN What is a community? A community can be defined either geographically or socially. A geographic community is recognized by attributes tied to physical appearance or location, such as natural boundaries, a recognized history, demographic composition, or the presence of certain industries or organizations. A socially defined community consists of people who share common social attributes and interests, such as language, customs, class, or ethnicity, regardless of geographical proximity.” (Chaskin et al., 2001)

5. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Constituencies Policy makers and Governments, mayors and parliamentarians Development partners- UN System, bilateral, NGOs Religious leaders and institutions Traditional/cultural leaders Media (print, electronic, entertainment education) Women and Youth organizations/networks Professional and labour organizations

6. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Community Involvements District/local/ Village health authority, and Community outreach Parents /family members Opinion and Community leaders Faith based groups/leaders Elected representatives Women and Youth groups/organisations Media, including entertainment education Traditional healers/Local drug vendors School teachers, Health Professional Associations, and others

7. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Does Community involvement work? Involving communities in development is good practice, because community members know their own needs and understand issues that influence their health. Few researchers used designs ranked as ‘strong’ in the traditional evidence grading system, but evidence exists “based on multi-level research designs that empowering initiatives (incl. CP) can lead to health outcomes and that empowerment is a viable public health strategy” (Wallerstein, 2006).

8. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Does Community involvement work? Reduction of HIV Prevalence in Uganda in 1990s, included community mobilisation and participation, beyond the A,B,C Evaluation of the African Youth Alliance SRH/HIV Programme in 4 countries, shows community participation contributed to the success. In addition to other measures, community participation was recorded as common factor to the initial success in Senegal, Thailand and Uganda.

9. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN What are the Challenges? There remains a need for more rigorous research designs to establish better empirical evidence of the contribution of community involvement to health outcomes, including PMTCT Development partners approach in communities may be more expensive than working with/through communities Takes time, but more productive

10. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN What are the four Prongs of PMTCT? Prong 1: Prevention of HIV among women of childbearing age and partners Prong 2: Prevention of unintended pregnancies in HIV+ women Prong 3: Prevention of HIV transmission from an HIV+ woman to her child, through ARV drug treatment or prophylaxis, safer deliveries and infant feeding counseling Prong 4: Care, treatment & support for the HIV+ mother and her family

11. What do we mean by maternal and child survival and virtual elimination of HIV? Childbearing Women living with HIV Pregnant women living with HIV HIV-infected children But we need wide-scale service coverage, quality services and interventions uptake Prevent new infections Avoid unintended pregnancies Prevent MTCT

12. The gap between antenatal care coverage and HIV testing and counseling in the context of PMTCT in selected countries – 2007

13. At what point do we intervene, where and with what interventions?

14. Young women aged 15-24 disproportionately vulnerable - about 2 to 4 times more likely to be infected than their male counterparts RegionFemaleMaleAdult HIV prevalence (those aged15+ years) Swaziland22.65.826.3 Lesotho14.95.923.2 Botswana15.35.122.5 South Africa12.74.018.1 Namibia10.33.415.3 Zimbabwe7.72.915.3 Zambia11.33.615.2 Sub-Saharan Africa 3.21.15.0

15. Preventing HIV infection in women Preventing HIV infection in all women (and their partners) Preventing HIV infection in pregnant women (and their partners) Within national multi-sectoral prevention strategies Specific interventions targeting pregnant women and their partners Prevention of HIV infection in women

16. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN HIV and AIDS Policies and Programmes Prevention, treatment, care and support activities. Home-based care and psycho-social support, Positive prevention and compliance with Treatment and Care by PLHIV, HIV prevention for the general population, condom provision, PMTCT, and Specific services for key populations

17. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Sexual and Reproductive Health Information and Services Family planning Prevention and management of STIs Maternal and newborn care Prevention and management of gender-based violence Prevention of unsafe abortion and post-abortion care Others e.g.- Prevention & screening cancer of the cervix

18. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Tools

19. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN PMTCT programming Guidance Strategies Elements for Prongs 1 & 2 1.Link SRH and HIV at the policy, systems and service delivery levels to ensure coordination for PMTCT elements 1 and 2 at national and district levels 2.Strengthen community engagement and community-based delivery of integrated SRH and PMTCT services 3.Promote greater involvement of men in MCH/STI/FP services 4.Engage CSOs including organizations of people living with HIV (PLHIV) in the development and implementation of PMTCT policies and programmes 5.Ensure non-discriminatory service provision in stigma-free settings

20. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN How do we Involve Communities? 1.Community Advocacy and building strategic alliances 2. The Participatory Learning And Action Assessing the situation – identify and prioritize problems Deciding what to do – identify solutions/strategies and prioritize solution Taking action and monitor progress Measuring progress – evaluate, learn and plan for the future

21. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Conclusions Community Involvement works Community involvement is more cost-effective Community involvement enhances support, acceptance and utilisation of PMTCT Community involvement is more sustainable Community involvement is empowering Community involvement needs more research documentation to show more evidences

22. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Thank You Merci