EngenderHealth/UNFPA Project – Ethiopia/Ukraine Strengthening the integration of HIV prevention in maternal health services. Increasing the capacity of MCH programme managers and health providers to undertake HIV prevention interventions for HIV-negative pregnant and post-partum. Increasing access for prevention, treatment, care, and support services for HIV-positive women and adolescent girls.

Cost Analysis The costs were calculated for the following prevention interventions: – Behaviour change communication materials – Group education sessions – HIV/STI prevention counselling (including condom demonstration/distribution and counselling on dual protection) – Voluntary counselling and testing Calculations of direct costs were based on staff time and service/clinical procedure-specific supplies for the above interventions. Calculations of indirect costs, including in-service training, renovations, meetings, and space, were based on dividing indirect costs among clients.

Average Costs and Savings CountryAverage cost of providing HIV prevention services to MCH clients at pilot sites ($US) Average savings in ARV treatment costs for averted infections in mothers ($US) Average savings in PMTCT treatment and OVC support for averted infections in mothers and infants ($US) Average net savings ($US) Ethiopia$ 2,016$ 60,480$ 10,976$ 69,440

RH and VCT centre integrated (India) Costs RH service alone = Rs. 130 VCT service alone = Rs. 86 Separate services = Rs.216 Combined services = Rs. 144 Population Council/USAID

Benefits of Adding Family Planning to PMTCT Services in 14 High Prevalence (PEPFAR) Countries, by 2007 Source: USAID:

Cost-effectiveness of adding family planning to PMTCT services PMTCTFP added to PMTCT Cost per infection averted1,300 USD 660 USD Cost per child death averted2,600 USD 360 USD Cost per pregnancy averted to HIV positive mother 130 USD Source: USAID:

Source: Bringing HIV Prevention to Scale, powerpoint presentation (amended), Global HIV Prevention Working Group, June 2007, Status of Prevention Efforts

Intensifying HIV Prevention – Policy Actions Promote, protect, respect human rights Build multisectoral leadership Involve people living with HIV Address cultural norms and beliefs Promote gender equality Promote knowledge and awareness Promote sexual & reproductive health and HIV linkages Support community- based responses Reach affected groups & populations Strengthen financial and human capacity Remove legal barriers to prevention Invest in new prevention technologies Intensifying HIV Prevention: UNAIDS Policy Position Paper

Intensifying HIV Prevention – Programmatic Actions Prevent sexual transmission of HIV Prevent mother-to-child transmission of HIV Prevent the transmission of HIV through injecting drug use, including harm reduction Ensure the safety of the blood supply Prevent HIV transmission in health-care settings Promote greater access to voluntary HIV counselling and testing while promoting principles of confidentiality and consent Integrate HIV prevention into AIDS treatment services Focus on HIV prevention among young people Provide HIV-related information and education to enable individuals to protect themselves from infection Confront and mitigate HIV-related stigma and discrimination Prepare for access and use of vaccines and microbicides Intensifying HIV Prevention: UNAIDS Policy Position Paper

Responsibility of men and boys for transforming their attitudes and behaviours in the household, society, and in the wider world through, e.g., comprehensive sexuality and gender education, and working with men on transforming models of masculinity to respect the human rights of women Strategies that empower women to exercise their rights, including to education, health services, political representation, economic opportunities, freedom from want, violence, and harmful cultural practices Gender Transformative Initiatives

Actions for Consistent & Correct Condom Use Increase supplies of quality male and female condoms Provide condoms free of charge or at affordable prices Increase and diversify distribution points Promote both male and female condoms for dual protection Address negative perceptions and myths about condoms with practical advice Build capacity of health providers and clients to negotiate condom use

Preventing HIV in women, especially young women and girls Initiate comprehensive sexuality education that promotes equality between men & women, skills building & respect for human rights Establish sexual and reproductive health care that integrates HIV Address legal and policy barriers to accessing SRH and HIV care (e.g. age of consent, etc.) Scale-up comprehensive PMTCT Build self-esteem and impart skills for equality in relationships. Enforce legal age of marriage and prevent child marriage Empower economically Eliminate stigma and discrimination against women and girls, due to their sex and HIV status