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Washington D.C., USA, 22-27 July 2012www.aids2012.org
“The Road to Washington”
Mobilizing communities to create a supportive environment to help end vertical transmission
Linda RichterInternational AIDS Conference, Washington DC
25th July 2012
Coalition on Children Affected by AIDS (CCABA) Symposium
Washington D.C., USA, 22-27 July 2012www.aids2012.org
CCABA’s mission .. children
• 2004 Bangkok• 2006 Toronto
- Families, scale, integration• 2008 Mexico plenary, JLICA
- Poverty, social protection• 2010 Vienna - Family-centred services• 2012 Washington – Community and PMTCT
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Why this road … ?
• CCABA’s mission … children• Global focus PMTCT – commitment,
opportunity for children, families• Avert narrowing of goals• Potential of “OVC community” capacity
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Most significant and substantial commitment to children and families since the start of the epidemic
Alive with opportunities …
GLOBAL COMMITMENTS TO PMTCT
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Vision: 4 prongs and more
• Primary prevention of HIV infections among sexually active young people
• Prevention of unwanted pregnancies• Prevention of vertical infection• Ongoing care for women, children & families
Integrated, family-centred care across the lifecycle
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Family-centred services
Washington D.C., USA, 22-27 July 2012www.aids2012.org
To achieve targets …Expanded, better-resourced health services with:
• Large scale efforts at stigma reduction• Involvement of affected women and
their families • Increased demand & barriers addressed• Follow up to ensure wellness• Use of PMTCT as an entry point for wider
services
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Community good at …
• Transmitting key messages – especially to hard-to-reach populations• Influencing & supporting household norms
and behaviour• Increasing access to services as go-betweens• Providing complementary services• Holding health services accountable
Washington D.C., USA, 22-27 July 2012www.aids2012.org
We know more, doing better
• Improved (opt-out) and expanded (community-based) testing• More efficacious PMTCT drugs• Expanded treatment for women and children• Better coverage, less transmission• Breastfeeding protected • Push to integrate with NMCH, SRH
Washington D.C., USA, 22-27 July 2012www.aids2012.org
What role for community?
• Help achieve aspirational targets - implementation challenges
- Demand, delivery and enabling environment
• Challenge inequity, assist with redress• Hold leaders accountable to their vision and
actions - eg targets – HIV-free survival at what age (6wks, 5y)? Survival and healthy development through social protection, care and support?
Washington D.C., USA, 22-27 July 2012www.aids2012.org
What can “community” do
• Advocate / demand:- Comprehensive, equitable quality services- Test and expand promising practices
• Improve community knowledge & norms• Help marginalized groups access services• Support women and families• Promote child health and development
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Implementation challenges
Too many:• women not reached• women and children not followed up and
treated• male partners and other children not
tested• families without support• opportunities missed
Washington D.C., USA, 22-27 July 2012www.aids2012.org
No of women attending ANC
No of women tested
No of women who receive their results
No of women who receive ARV/ART
No of babies tested, treated
No of women tested, treated
No of families followed up
Too many women, children and families lost
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Promising practices
• Couples, home-based testing (disclosure, links to treatment, ID +children)
• Fertility choices for HIV+ couples• Routine 6-week testing of all infants• Involvement of men (PMTCT, child health
& development)• Family-centred approaches• Companionship
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Support women & families
• Economic support• Cash transfers, treatment subsidies• Incentives to overcome opportunity costs
– transport, food etc• Health support • Mentors, buddies, CHWs
• Social support• Companionship, support groups, home
visits
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Promote child development
Knowledge, support, assistance for:• Good nutrition in pregnancy, early
childhood• Immunization and health care• Care for development – play, language• Reduction of harsh punishment• Child care and protection• Stimulation, school readiness, support for
schooling
Washington D.C., USA, 22-27 July 2012www.aids2012.org
“OVC” community can help
• Massive “workforce”, committed to the wellbeing of children• Many trained and organized• Extensive networks with deep penetration in communities• Experienced in working holistically and with families on behalf of children
Washington D.C., USA, 22-27 July 2012www.aids2012.org
“OVC” community can helpDevelopment of responses to children across time
Washington D.C., USA, 22-27 July 2012www.aids2012.org
The Concept of 0 Child HIV
Massive, public, accountable commitment to children
Needs a huge, comprehensive effort
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Road to Washington
• Geneva Meeting May 2011• Addis Meeting December 2011• JIAS Special Issue • Pamphlet to support community action• Partnerships and collaborations – eg
key populations, IATT CEWG• London Meeting February 2012• Washington activities July 2012
Washington D.C., USA, 22-27 July 2012www.aids2012.org
What did we hear?• Inability to reach, enrol and retain women and children• Reviews of community work • Very large scale programmes integrated with
formal health services• Innovations eg MAMA+• Voices of affected groups• Needs of community groups – recognition,
training, resourcing & support
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Slides from Ryan Phelps and Ade Fakoya
Washington D.C., USA, 22-27 July 2012www.aids2012.org
By logic model, depth of engagement and level of social processes
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Slides from Pininah Kyalimpa-Nyimbwa
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Slides from Roman Yorick
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Slides from Ginna Anderson
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Slides from Buyi Ntaka
Washington D.C., USA, 22-27 July 2012www.aids2012.org
http://www.jiasociety.org
Washington D.C., USA, 22-27 July 2012www.aids2012.org
JIAS Special IssueCommunity Action to End Paediatric HIV
Infections
• Foreword by M Sedibe and E Goosby• Editorial - introduction• 10 papers• Note on ‘Language, identity and responses to the
HIV and AIDS epidemic’ – women living with HIV, through ICW and GNP+
Washington D.C., USA, 22-27 July 2012www.aids2012.org
http://www.ccaba.org
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Key messages• Hope and encouragement• Support and
companionship• Partner testing• Disclosure• Norms and stigma• Adherence• Infant feeding• Health promotion,
mental health
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Good ways to hold hands
Health services and systems
Community action (especially OVC groups)
Wellbeing of children and families