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Preventing HIV Infection
Strategic Guidance
on HIV/AIDS Prevention
Purpose of the Guidance Note
Strategic Orientation for UNFPA Action
Integrating HIV/AIDS Issues into the Country Programming Process
Country Situations
Core Support
Creating an Enabling Environment for HIV Prevention
Advances in New Technologies and Issues
The Way Forward
ICPD+5 Goals
Regional HIV/AIDS Statistics
Core Support

Preventing HIV Infections in Young People
Condom Programming in the Context of STI/HIV Prevention
Preventing HIV Infections in Pregnant Women

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Preventing HIV Infections in Pregnant Women

An estimated 200 million women become pregnant each year, of whom only about 1.8 million are HIV positive. Thus, 99 per cent of pregnant women are HIV negative. Even in countries where HIV prevalence is high, many women are HIV negative.

In most developing countries, pregnancy is the one time when women seek access to health services. Thus, their contact with health services is an opportunity to ensure that they remain healthy. By preventing HIV infection in the mother in the first place, prevention of transmission to her unborn child is assured.

However, women have the right to remain free from STI/HIV infections not only because they should not transmit infection to their babies but for their own sake as individuals.

In the face of limited resources, concentrating efforts on the majority – that is, on uninfected women — has been the basic rationale for UNFPA’s focus on pregnant women. UNFPA stresses the importance of ensuring that pregnant women remain HIV negative during pregnancy and delivery and while breastfeeding their babies.

The UNGASS Declaration of Commitment on HIV/AIDS calls on all Governments to:
"by 2003, reduce the proportion of infants infected with HIV by 20 per cent, and by 50 per cent by 2010, by ensuring that 80 per cent of pregnant women accessing antenatal care have information, counselling and other HIV prevention services available to them."

UNFPA collaborates with other UN partners, notably UNICEF and WHO, to contribute to bringing about a comprehensive programme for HIV prevention in pregnant women, mothers, and their children to meet the relevant UNGASS goals, but also in the context of its mandate to promote safe motherhood and provide quality maternal health care.

Risk factors that make pregnant women more vulnerable to the acquisition of HIV include, in certain social and economic settings, their difficulty in obtaining control over their sexual relations, particularly during pregnancy; the presence of STIs, often asymptomatic in women, which increase their vulnerability to HIV infection; limited access to antenatal services early in pregnancy and the limitations of antenatal services themselves, which sometimes provide little access to voluntary counselling and testing (VCT) services or even to basic screening for curable STIs; and limited knowledge about or accessibility to commodities which would permit them to adopt safer sexual practices, such as the importance of barrier methods to protect pregnant women, irrespective of their HIV status, from STIs and from re-infection with HIV in HIV-positive pregnant women. Early antenatal care is especially important for young mothers.

UNFPA should consider appropriate attention to prevent HIV infection in pregnant women. Prevention should be integrated into reproductive health programmes that aim at preventing unwanted pregnancies through adequate family planning services, preventing and managing STIs and providing maternal health. As always, interventions should be designed within the framework of maternal health and reproductive rights of pregnant women.

Making comprehensive interventions widely available depends upon the ability to influence political will and policy formulation, to strengthen human resources and infrastructures, and to mobilize enough funds to implement an intervention package.

In this respect, UNFPA must provide technical and policy support to strengthen, at the national level, the capacity to plan, design and integrate STI/HIV-prevention services for pregnant women into the existing reproductive health services; advocate for support and the building of partnerships among interested parties to ensure continued attention to women’s needs, to maximize available resources and to ensure better coordination and integration of maternal health interventions.

UNFPA should ensure that the development and dissemination of IEC/BCC messages and materials on the prevention of HIV infection in pregnant women are available as well as tools and protocols on HIV prevention among pregnant women aimed at strengthening the skills of maternal health care providers.

UNFPA support may include the integration of programmes that educate outreach community volunteers and community health workers to provide to pregnant women, families and communities information on HIV/AIDS and STIs, VCT, safer sexual practices (including condom use), breastfeeding and the importance of proper antenatal delivery and postnatal care.

The Fund would also need to further facilitate access to procurement of reproductive health commodities – primarily commodities for HIV prevention such as STI and HIV test kits, male and female condoms, equipment and supplies for safe and clean delivery and drugs for the treatment of STIs and assist in the maintenance of functional and efficient logistics systems.

Recommended Intervention Package

UNFPA should integrate the following intervention package for the prevention of infection among pregnant women in its supported maternal health care interventions.

The package includes:

  • Providing access to VCT services so that pregnant women can find out their HIV status and thereby adopt safer sexual practices;

  • Providing access to appropriate antenatal, safe delivery and post-delivery care, including screening and treatment for STIs and access to trained personnel for the care of the mother during pregnancy, and for safe delivery.

  • Avoiding unnecessary interventions during delivery, such as routine episiotomy and early rupture of membranes; and balancing benefits and risks associated with caesarean section; and

  • Supplying and managing reproductive health commodities, in particular, those for HIV prevention: male and female condoms, HIV testing kits, STI screening and diagnostic kits, equipment and supplies for safe and clean delivery, and drugs for the treatment of STIs.

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