women, women living with disabilities, mothers or pregnant women who inject drugs, and women and their accompanying children in prisons. In addition to the challenge of discrimination from service providers, these women may have fears regarding child custody. Fear of disclosing their own status may inhibit mothers from enrolling children in HIV treatment programmes, especially when there is an obligation to consult other family members about health-care decisions.104
Strengthening monitoring and evaluation will require more focused data-driven planning and analysis of results with equity in mind. Multi-partner support will be not only desirable, but a prerequisite for achieving results that combine to serve the most disadvantaged and excluded. More effective monitoring and evaluation of programmes at the primary health-care level will also help local decision makers improve programme performance. For example, bottleneck analyses were conducted in each of the 22 Global Plan priority countries to identify specific entry points for improvements and to inform costed EMTCT plans for each country. This is a good example of how partnerships and tailored tools can add value and accelerate the pace of progress.
Community engagement is a key approach to tackling HIV-related stigma and discrimination while providing support to children and families living with HIV. An eight-country analysis found that in nearly all settings, community-driven advocacy helps identify and publicize obstacles to HIV treatment access, addresses stigma and discrimination, and promotes human rights and changes to obstructive and discriminatory laws and practices.105 Leadership at all levels is essential to promote law reform and put in place supportive policies that contribute to an enabling environment for the response to HIV among women and children.
As the new approaches described in this section are scaled up, operational research is essential to guide implementation, especially to identify best practices for the delivery of HIV interventions for women and children in primary-care and community-based settings, and to optimize synergies between HIV programming and child and social protection efforts. Answering questions regarding overall transmission rates and the impact of HIV-related programming on maternal and infant morbidity and mortality should be high priorities, along with continuing research on the safety of lifelong ART for pregnant and breastfeeding women. Clinical research can also lead to expanding the range of available interventions for women and children, including improved paediatric treatment options, microbicides and vaccines.
Š UNICEF/NYHQ2011-0268/Nesbitt
11. E xpand the knowledge base through research, monitoring and evaluation
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