“Breaking the chain of transmission” Beean K, 12 th July UNICEF, India

Brief context Good News: Reduction of over all new infections national level by 56% Efficacious –Multidrug regimen for prevention of Mother to Child Transmission (MTCT) MTCT lees than 1% _________________________________________ Andhra Pradesh contribute to 20% of new infection 50% in age group 15-49, 39% women People living with HIV in AP : Annual coverage : 70% and detecting 50% of estimated new infection Of every 100 children born in India 4.4 will die before their first birthday. untreated HIV infected child may not 1 st Birthday

Work Done So Far & moving towards elimination goal PPTCT : UNICEF key partner Early 2000 : PPTCT prog developed 2012 : Government of India roll out efficacious multi drug for prevention of Parent to child transmission of HIV in Andhra and Karnataka : 8-12 % infection among children born to infected mother Where to by 2015 – less than 5% MTCT !

Social Norm perspective An opportunity to strengthen MTCT in India Health care providers discriminate Health care providers refuse to provide treatment All people living with HIV are not taking treatment and are still alive All children born to HIV infected mothers are not infected with HIV Death is inevitable, so why take treatment It is unsafe to treat infected women Loose clients Social norm perspective has not been taken in to consideration while MTCT programme planning, assessment or interventions

Social Norm perspective An opportunity to strengthen MTCT in India HIV infected women think that health care providers expect them not to access services 1.Health care providers factual belief of their safety 2.Moral judgment and attitude towards the infected women among health care providers 3.Women’s understanding of right to life and dignity Schema: Infected women have low moral values, no right to dignity HIV infected women do not seek health care Health care providers refuse treatment Women do not others doing it Do not think other women expect then to go There is a sanction to the behavior.

Engaging Professional bodies, Health care workers – motivation, commitment Trust relationship Integrating with Adolescent programme and RCH – Call to Action & MARPU Private partnerships, other stakeholder Engagement at community level Leveraging Net work of People living with HIV Existing programme+ Call to Action Strategic Approaches

Assessment – Reference network- network analysis Comprehensive activities for sustaining change and reporting framework Strategic intervention Value deliberation Value deliberation discussion forums to facilitate dialogue what is envisaged and collaboration, trust relations, Structured, guided diffusion individual level, groups- District to state including private sector

Sufficient number of women believing in seeking health for themselves and keeping their children HIV free Critical mass of Health care professionals become change agents

Social Network Analysis network mapping and social network analysis needed. A another women living with HIV, a friend, high degree node with the strongest tie Trusted professional collegaue, senior mentor – strong tie Community Health care workers bridge between networks Counsellors can be a bridge

How change may occur Based on assessment and social network analysis identify referral groups, core group Professional bodies, Union, net work of positive women, women group Identify a influential and trusted person within core group who is trained or can be trained Facilitate value deliberations Understand interdepended issues, unseen behaviors and bring in a collective understanding - willingness to change Bring the enabling environment through correct information, knowledge, strengthening social ties Trigger the power with in and facilitate diffusion

How to sustain change Organize periodic deliberations continue dialogue Recognize positive trend setters _ client friendly Hospital, model mother Facilitate advocacy to tackle issues beyond the norms – access, supply Create an Excitement around Elimination : Track progress and announce Loudly Enhance communication activity at all levels as appropriate –conferences, media, Television, radio National trend setter – to break the chain of transmission

Organized Diffusion Small scale in group, individual to higher level – district state and story for country.. amplifying Creation common knowledge discussions in homogeneous group, separate groups Women, health workers to community… Common goal There will be a national environment translating to support the process – Declaration of the commitment – Organized Diffusion- to others – Sustain through commitment – amplify, sustain … success story

Thank you