“Breaking the chain of
transmission”
Beean K ,
12th July
UNICEF, India
Brief context
Good News:
• Reduction of over all new infections national level by 56%
• Efficacious –Multidrug regimen for prevention of Mother
to Child Transmission (MTCT)
• MTCT lees than 1%
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• Andhra Pradesh contribute to 20% of new infection
• 50% in age group 15-49, 39% women
• People living with HIV in AP : 520000
• Annual coverage : 70% and detecting 50% of estimated
new infection
Of every 100 children born in India 4.4 will die before their first birthday.
untreated HIV infected child may not 1st Birthday
Work Done So Far & moving towards elimination goal
• PPTCT : UNICEF key partner
• Early 2000 : PPTCT prog developed
• 2012 : Government of India roll out
efficacious multi drug for
prevention of Parent to child
transmission of HIV in Andhra and
Karnataka
• 2011-12 : 8-12 % infection among
children born to infected mother
• Where to by 2015 – less than 5%
MTCT !
• Health care providers discriminate
• Health care providers refuse to
provide treatment
Social norm perspective has not been taken in to
consideration while MTCT programme planning,
assessment or interventions
• All people living with HIV are not
taking treatment and are still alive
• All children born to HIV infected
mothers are not infected with HIV
• Death is inevitable, so why take
treatment
• It is unsafe to treat infected women
Social Norm perspective An opportunity
to strengthen MTCT in India • Loose clients
HIV infected women do not
seek health care
Health care providers refuse treatment
•
•
•
.
Women do not others doing it
Do not think other women expect then
to go
There is a sanction to the behavior
HIV infected women think that health
care providers expect them not to access
services
1. Health care providers factual belief of
their safety
2. Moral judgment and attitude towards
the infected women among health
care providers
3. Women’s understanding of right to
life and dignity
Social Norm
perspective An Schema: Infected women have low moral
values, no right to dignity
opportunity to
strengthen MTCT in
India
Strategic Approaches
Engaging Professional
bodies, Health care workers
– motivation, commitment
Trust relationship
Leveraging Net work of
People living with HIV
Existing
programme+
Call to Action
Integrating with Adolescent
programme and RCH – Call
to Action & MARPU
Private
partnerships,
other stakeholder
Engagement at
community level
Strategic intervention
Assessment – Reference
network- network analysis
Value deliberation discussion
forums to facilitate dialogue what
is envisaged and collaboration,
trust relations,
Structured, guided diffusion individual
level, groups- District to state including
private sector
Comprehensive activities for sustaining
change and reporting framework
• Sufficient number of women believing in
seeking health for themselves and keeping
their children HIV free
• Critical mass of Health care professionals
become change agents
Social Network Analysis
network mapping and social network analysis needed.
A another women living with HIV, a friend, high degree
node with the strongest tie
Trusted professional collegaue, senior mentor – strong tie
Community Health care workers bridge between
networks
Counsellors can be a bridge
How change may occur
• Based on assessment and social network analysis identify
referral groups, core group
• Professional bodies, Union, net work of positive women,
women group
• Identify a influential and trusted person within core group
who is trained or can be trained
• Facilitate value deliberations
• Understand interdepended issues, unseen behaviors and
bring in a collective understanding - willingness to change
• Bring the enabling environment through correct
information, knowledge, strengthening social ties
• Trigger the power with in and facilitate diffusion
How to sustain change
• Organize periodic deliberations continue dialogue
• Recognize positive trend setters _ client friendly
Hospital, model mother
• Facilitate advocacy to tackle issues beyond the
norms – access, supply
• Create an Excitement around Elimination : Track
progress and announce Loudly
• Enhance communication activity at all levels as
appropriate –conferences, media, Television, radio
National trend setter – to break the chain of
transmission
Organized Diffusion
Small scale in group, individual to higher level –
district state and story for country..
amplifying
• Creation common knowledge discussions in
homogeneous group, separate groups Women,
health workers to community… Common goal
• There will be a national environment translating
to support the process
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Declaration of the commitment
Organized Diffusion- to others
Sustain through commitment
amplify, sustain … success story
Thank you