PMTCT Prongs 1 & 2 and the repositioning of Family Planning ICASA 2011 George Tembo UNFPA

Global Plan Towards the Elimination of New HIV Infections by 2015 and Keeping Their Mothers Alive

Global targets by 2015 : • Reduce new HIV infections in children by 90% • Reduce AIDS-related maternal deaths by 50% 2

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Number of new HIV child infections if: - PMTCT coverage/regimen at 2009 levels - Prong 3 (ARV/ART to 90% of HIV+ PW) - Prongs 1, 2 and 3 (50% reduction Incidence, unmet FP to Zero, and 90% ARV/ART) - Prongs 1, 2, and 3 and limit BF to 12 months Estimated New HIV infections among children: Different scenarios for 25 countries Value in 2015 (% reduction) 367,000

400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 345,000 2009 216,000 2010 184,000 2011 153,000 2012 123,000 2013 96,000 2014 72,000 2015

138,000 (60%) 95,000 (73%) 72,000 (79%)

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Prong 1: Primary Prevention of HIV Target: 50% incidence reduction in women of reproductive age

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Why prong 1 is important

HIV negative women remain negative; pregnancy and breastfeeding

• Reduce number of reproductive age/maternal deaths • Reduce number of new HIV-positive infants, and improve child survival.

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Prong 1 Challenges

• Engaging male partners • Lack of awareness of HIV risk and how to prevent HIV • Insufficient coverage and quality of HIV counseling and testing • Inadequate condom use and STI management • Lack of access to ARV treatment 8

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Prong 2: Prevention of unintended pregnancies Target: Reduce unmet family planning need to zero, all women 10

Why prong 2 is important

Reducing unintended pregnancies will: • Reduce maternal deaths and improve maternal health, • Reduce new HIV positive infants, • improve child survival, keeping mothers alive • Empower women .

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Prong 2 Challenges • Unintended pregnancies, unmet need for family planning • Lack of awareness of reproductive rights • Stigma in health care settings and community • Inadequate availability, access to family planning services 12

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Framework for Preventing HIV and Unintended Pregancies: supports Global Plan

1.Stigma-free integrated SRH and HIV services 2. Key entry points to integrating services for HIV and sexual and reproductive health 3. Strengthen national programme implementation 4. Carry out five key strategies 15

Framework Strategies

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Strategy 1:

Link SRH and HIV 

Strategy 2:

Community Engagement 

Strategy 3

: Promote greater involvement of men 

Strategy 4

: Engage organisations of PLWHV 

Strategy 5:

Non-discriminatory service provision 16

Repositioning Family Plannning

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Implement advances in treatment/prevention

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Coordinate for synergies between SRH/MNCH and HIV

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Eliminate stigma and discrimination

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Go beyond the health sector response

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