8. R einforce safer breastfeeding efforts and messaging
120 programmes implemented between 2000 and 2009 to about 245 programmes in 2012 – with an estimated US$10 billion supporting cash transfer programmes in 2012 alone.93
The 2013 WHO guidelines on ARVs emphasize that the risk of post-natal HIV transmission through breastfeeding will be minimized as countries transition towards offering ART to all pregnant women living with HIV, as long as they continue on treatment without any lapses. Women who are breastfeeding should do so exclusively – giving their infants only breast milk, without any other kind of food or liquid, up to 6 months of age.98 Women need to be supported in doing this, and these messages should be reinforced in all breastfeeding programming.
Social protection has already proven to have an impact not only in support for children and families already affected by HIV, but also in preventing HIV and improving treatment and care outcomes.94 The opportunity exists now to tailor these programmes to include HIV-affected populations, extending the support they offer to include transportation to clinics, nutrition support, cash transfers for poor households, psychosocial support and palliative care services. In Zambia, the inclusion of early childhood development in the Education Sector Plan (2012– 2015) seeks to expand access to schooling and improve educational quality and equity, especially for orphans and vulnerable children and children affected by HIV and AIDS.95
9. S trengthen primary HIV prevention and family planning services Every new HIV infection in a child also represents a failure of primary HIV prevention for women and girls. Pregnant women may be at increased risk of HIV acquisition and transmission, and rates of sero-conversion (the development of antibodies) during pregnancy can be significant, particularly in high HIV prevalence settings. Comprehensive HIV prevention programming for women and girls, including pregnant women in antenatal care, needs to be reinforced.
Community- and faith-based services have a long tradition of providing HIV-related (health, social and economic) services in rural and remote areas. In Malawi, for example, case management performed by community health workers has resulted in improved retention in care and higher utilization of antenatal and post-natal services for mother-baby pairs. While these approaches have not been brought to scale in many settings,97 their value is increasingly recognized, especially in rural areas. However, over-reliance on volunteers cannot adequately compensate for a lack of government infrastructure and services. Building effective and sustainable community systems requires human and financial resources, and partnerships between community members and the health, social welfare, child protection, legal and political systems.
© UNICEF/NYHQ2011-1692/Pirozzi
In India, mechanisms are being put in place to reduce out-of-pocket expenses for people affected by HIV and support access to primary health care, including through call centres coordinating free and low-cost transport.96
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