KAIS 2007 1 - Kenya National AIDS & STI Control Programme ...

8.12 GAPS AND UNMET NEEDS• Although ANC attendance rates were high, one in 10 women did not attend anANC and could not access PMTCT services. Efforts should be directed toreaching those women not attending an ANC.• ANC testing increased over the years, but gaps still remain: some womenattending ANC in 2007 were not offered HIV testing. Additional efforts arerequired to ensure “opt-out” HIV testing is offered to all ANC attendees as wellas testing options for sexual partners.• Most ANC attendees received testing and counseling for HIV; considerationshould be given to the future use of PMTCT program data to replace ANCsentinel surveillance.• ANC attendance was low among women in their first and second trimesters ofpregnancy. A greater number of women may have exposure to HIV testing andPMTCT services if ANC begins earlier in pregnancy. Early prenatal care shouldbe a priority.• Prevention of HIV infections in pregnant and breastfeeding women must beaddressed; among HIV-uninfected pregnant or breastfeeding women whoreported having unprotected sex, the majority of their sexual relationshipswere with men whose HIV status was unknown to them.• There is a large unmet need for family planning among all women; this needshould be addressed most urgently among HIV-infected women. Fertilitydesires among women were significantly associated with knowledge of HIVstatus, but contraceptive use was not. Fertility desires should be considered inconjunction with contraceptive options.KAIS 2007 162