PMTCT Prevention of Mother-to-Child Transmission of HIV

1. PMTCTPrevention of Mother-to-Child Transmission of HIV Module 2: Primary Prevention of HIV and Prevention of Unintended Pregnancies in HIV Positive Women

2. Learning Objectives By the end of this module the participants will be able to: • Describe the first two prongs of PMTCT • Describe the main modes of HIV transmission • Discuss risk factors in HIV transmission • Describe HIV prevention strategies • List the most common myths and misconceptions about PMTCT, HIV and AIDS

3. Learning Objectives contd. • Discuss cultural and social barriers to accessing of primary prevention methods. • Explain why all family planning clients should access CT. • Describe family planning counselling • Classify & describe the various FP methods available in Zambia • Explaining what double protection is and why it is important

4. Prong 1: Primary prevention of HIV infection • Primary prevention of HIV is the first of the four prongs of PMTCT. • Young adult or adolescents are identified as a group within the community who are particularly at risk. • Prevention of HIV infection in this category of parents-to-be contributes significantly to PMTCT

5. Modes of Transmission of HIV • Unprotected sexual intercourse with a partner who is infected with HIV • Contact with HIV-infected blood or body fluids • Mother to child transmission

6. Risk Factors in HIV Transmission • Socioeconomic Factors • Cultural Factors • Behavioural Factors • Biological Factors

7. High Risk Sub-Populations • Every sexually active person is at risk of contracting HIV and as such should be considered to be at high risk • However, it is important to realize that some sub-populations may be at even higher risk

8. High Risk Sub-Populations (cont) • Examples of high risk sub-populations: • Adolescents • Sex workers • Sexually active people living away from home or travelling frequently • Discordant couples

9. Discordant couples • “The highest risk individual may be the faithful negative spouse (or regular partner) of a faithful infected person

10. Primary Prevention Strategies Strategy 1- Access to and use of free, subsidized, and/or commercially marketed condoms • Condoms are effective against HIV transmission when used correctly and consistently

11. Primary Prevention Strategies contd. Strategy 2: Behaviour change communication • Abstinence • Be Faithful – to a partner who’s not infected and is faithful to you • Condom Use – correctly and consistently

12. ABC+ • Be tested, be knowledgeable & be safe • Empower women to protect themselves • Male circumcision • Does not protect you from HIV • But, evidence shows that it may reduce the risk of transmission of HIV and other STIs

13. Primary Prevention Strategies contd. Strategy3- Reducing HIV risk among women of reproductive age • Improving women’s status in the society • Providing information of HIV/AIDS and it prevention • Promoting safer sex and early treatment of STIS • Facilitating behavioral change (e.g. onset of first intercourse)

14. Primary Prevention Strategies contd. Strategy4- Prevention, early diagnosis and treatment of STIs • Early diagnosis and treatment of STIs can reduce the incidence of HIV in the general population by about 40% • STIs services present an opportunity to provide information on HIV infection,MTCT, and referral for TC

15. Definition of “myths” • “Myths” are unreliable information based on non-existing phenomena. Myths become widely known and are believed to be true, but often are inaccurate or false.

16. Definition of “misconception” • “Misconceptions” are misrepresentations of facts. They may also be referred to as misunderstandings.

17. Myths and Misconceptions • Take a minute and turn to the person next to you • Discuss and list some of the Myths and Misconceptions related to HIV and PMTCT that are common in your areas

18. Common Myths & Misconceptions • Women with HIV always have a baby with HIV • You can be cleansed of HIV if you have sex with a virgin or a child • You acquire AIDS after having sex with a woman who has just aborted • Condoms come already laced with the AIDS virus • Pregnant Women do not need to use condoms

19. Common Myths & Misconceptions (cont) • If you take Nevirapine, you cannot get pregnant again • Blood taken for VCT is to be used for satanic rituals • Transmission during pregnancy takes place through direct blood circulation between mother and foetus via the umbilical cord. • HIV/AIDS can be transmitted through a mosquito bite

20. Prong 2: Prevention of unintended pregnancies among women infected with HIV • Effective family planning can help prevent unintended pregnancies and help women who are HIV-infected protect their own health while taking care of their families. • Providing safe and effective contraception and high-quality reproductive health counseling contribute to informed decision-making about pregnancy choices

21. Definition of key terms • Family Planning: Family planning is a voluntary decision made by an individual or a couple or family on the appropriate number of children they wish to have, and when to have the children. • Contraception: Contraception is the prevention of unwanted pregnancy and contraceptive is a method of preventing fertilization of the ovum by spermatozoid. • Sexually Transmitted Infection: These are infections that can be spread from one person to another by sexual contact.

22. Promotion of HIV CT in the context of family planning • When a client is being counselled for family planning, this means that the client is sexually active. Any sexually active person should be counselled on the use of CT services, because HIV prevalence in Zambia is high and everyone is at risk

23. Family Planning Counselling • GATHER • Greet • Ask • Tell • Help • Explain • Return

24. Client Profiles • Profiling can help focus and improve the quality of FP counselling and education • Spacers/Delayers • Limiters • Breast feeders • Multiple partners

25. FAMILY PLANNING METHODS GROUP WORK (Use reference manual) • Natural methods • Barrier methods • Combined oral contraceptives • Progesterone only preparations

26. Family planning methods cont • Intra uterine device • Permanent methods

27. Double protection / Dual protection • The use of family planning methods to protect individuals from both unintended pregnancy and sexually transmitted diseases including HIV/AIDS

28. Methods for Double Protection • Correct and consistent condom use combined with another, effective contraceptive method

29. Summary Primary Prevention Strategies • Access to and use of free, subsidized, and/or commercially marketed condoms • Behaviour change communication efforts • Reducing HIV risk among women of reproductive age • Prevention, early diagnosis, and treatment of STIs

30. Summary Cont… • Effective family planning can help prevent unintended pregnancies and help women who are HIV-infected protect their own health while taking care of their families. • Providing safe and effective contraception and high-quality reproductive health counseling contribute to informed decision-making about pregnancy choices and is a vital component to reducing maternal and child morbidity and mortality.

31. Summary Cont… • The most effective means of prevention of transmission are the “ABCs” • Know what the local myths and misconceptions about HIV are in the communities you serve and develop effective strategies to overcome them and help educate your clients.