Missing the Target #7: Failing Women, Failing Children - HIV, Vertical Transmission and Women’s Health

According to this report, HIV-positive women provided with testing, counselling, and comprehensive prevention and treatment, including the best drug therapies available, can prevent the vertical transmission of HIV to their newborn children (PMTCT). However, women in the economically poor countries, particularly in the Global South, are not receiving what they need to prevent vertical transmission. Moreover, as stated here by the publishers of the report, the International Treatment Preparedness Coalition (ITPC) and ITPC's Treatment Monitoring & Advocacy Project (TMAP), governments and United Nations agencies have failed to meet their international commitments - for example, the goal of halving infections in infants by 2010 - and should be called to account.

This document recounts why there are over 900 new cases of HIV in babies in developing countries every day (data from 2009). It states and supports its position that "United Nations agencies and global funding initiatives (such as the Global Fund and PEPFAR [United States President's Emergency Plan for AIDS Relief]) have fundamental responsibility for realising the potential of comprehensive services to prevent vertical transmission of HIV." Coordination of agencies, research transparency, and increased programmes are part of what is advocated, as well as favouring "governments that show a clear interest in developing realistic policies and programmes to reduce vertical transmission by global funding partners."

Other international recommendations include:

• The United Nations (UN) should hold an international summit to assess global barriers to scale up vertical transmission services and publish a plan of action to increase quality coverage.
• The Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO), and The United Nations Children's Fund (UNICEF) should measure and report progress made in preventing vertical transmission based on all four prongs of the UN’s comprehensive strategy for its June 2010 United Nations General Assembly Special Session (UNGASS) meeting.
• Governments should increase access to the most effective triple-dose prophylaxis regimen.
  
• Governments should issue revised national infant feeding policies.
  
• Donors and governments should increase funding and implementation prevention programmes.
• UNAIDS, United Nations Population Fund (UNFPA), and UNICEF should provide technical support to governments to better integrate programmes.
  
• Governments should revise the programme and increase budget allocations in order to treat women, children and families.

The document has assembled 6 country reports on studies of services HIV-positive pregnant women receive for PMTCT. Each report has a set of recommendations specific to that country. Among the recommendations are the following communication-related strategies:

• Develop gender-based HIV/AIDS prevention programmes that focus on the specific risk factors and needs of women, and include peer education components.
  
• Incorporate people living with HIV/AIDS (PLWHA)-provided peer counselling in all strategies and programmes related to prevention of vertical transmission.
  
• Integrate services and mobilise resources internationally, nationally, and locally - sexual and reproductive health care and family planning are essential interventions for HIV prevention, care, and treatment. Include women from at-risk groups in the design and planning of programme delivery.
• Reduce HIV-related stigma and discrimination.
  
• Train health workers for sensitivity to human rights and gender-specific issues and compliance with principles of informed consent and confidentiality.
  
• Enhance coordination between HIV/AIDS services and anti-violence referral services.
• Promote treatment literacy among women and children living with HIV.
  
• Improve civil society's capacity for and representation in policy advocacy and monitoring of HIV-related policies and programmes at national and local levels.
  
• Improve financial support for HIV-positive women and encourage male partners of pregnant women to be tested for HIV and engage more fully in prevention of vertical transmission services as part of a broader effort to involve the entire family in HIV treatment and care.
  
• Develop and distribute HIV and prevention of vertical transmission education materials for pupils and students, teachers, and parents.
  
• Create a series of advertisements for TV, radio, and newspapers that focus on reducing HIV-related stigma and discrimination against women.
  
• Initiate a wide-ranging campaign to raise the level of awareness about prevention of vertical transmission programmes and services.
  
• Mobilise and encourage HIV-positive mothers to form or join psychosocial support groups that can also help them engage in income-generating activities.
  
• Streamline reporting by initiating a web-based format to improve access to quality data for programme monitoring and evaluation. This step would also help facilitate efficient distribution of drugs, test kits, and other supplies.
  
• Ensure that all health care workers receive adequate training in breast-feeding management and counselling, particularly as it pertains to HIV-positive mothers, in order to ensure that all expectant mothers understand the potential risks and benefits of all options and feel as though they can make realistic choices that will help keep their infant as well-fed and healthy as possible.