Washington D.C., USA, 22-27 July 2012 “The Road to Washington” Mobilizing communities to create...

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


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


Why this road … ?

• CCABA’s mission … children• Global focus PMTCT – commitment,

opportunity for children, families• Avert narrowing of goals• Potential of “OVC community” capacity


Most significant and substantial commitment to children and families since the start of the epidemic

Alive with opportunities …

GLOBAL COMMITMENTS TO PMTCT


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


Family-centred services


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


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


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


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?


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


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


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


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


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


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


“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


“OVC” community can helpDevelopment of responses to children across time


The Concept of 0 Child HIV

Massive, public, accountable commitment to children

Needs a huge, comprehensive effort


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


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


Slides from Ryan Phelps and Ade Fakoya


By logic model, depth of engagement and level of social processes


Slides from Pininah Kyalimpa-Nyimbwa


Slides from Roman Yorick


Slides from Ginna Anderson


Slides from Buyi Ntaka


http://www.jiasociety.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+


http://www.ccaba.org


Key messages• Hope and encouragement• Support and

companionship• Partner testing• Disclosure• Norms and stigma• Adherence• Infant feeding• Health promotion,

mental health


Good ways to hold hands

Health services and systems

Community action (especially OVC groups)

Wellbeing of children and families

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