PREVENTING HIV AND UNINTENDED PREGNANCIES ... - UNFPA

ExecutivesummaryWe are at a turning point for delivering on the promise to end childand maternal mortality and improve health – marked by bold newcommitments. This strategic framework supports one such commitment,the 'Global Plan Towards the Elimination of New HIV Infections amongChildren by 2015 and Keeping their Mothers Alive'. It offers guidance forpreventing HIV infections and unintended pregnancies – both essentialstrategies for improving maternal and child health, and eliminating newpaediatric HIV infections.This framework should be used in conjunction with otherrelated guidance that together address all four prongsof eliminating mother-to-child transmission of HIV. Thisdocument focuses on strengthening rights-based polices andprogramming within health services and the community for:■ Prong 1: Primary prevention of HIV in women ofchildbearing age (with special emphasis on pregnant andbreastfeeding women)■ Prong 2: Prevention of unintended pregnancies inwomen living with HIV (as part of rights-based sexualand reproductive health (SRH) of people living with HIV(PLHIV)).Prongs 1 and 2, together with safer infant feeding (prong3), and treatment (prongs 3 and 4), are essential forimproving the lives of women and children and eliminatingmother-to-child transmission of HIV (eMTCT). Therationale for prongs 1 and 2 includes:■ Remaining HIV-negative, particularly throughout pregnancyand breastfeeding (period of higher risk) protects infantsand children from becoming HIV-positive by eliminating thepossibility of HIV transmission from the mother.■ Primary prevention of HIV improves survival and wellbeing;HIV is the leading cause of death among womenof childbearing age, contributing significantly to maternalmortality.■ The benefits of family planning are far-reaching, rangingfrom fewer maternal and newborn deaths and healthiermothers and children to increased family savingsand productivity, better prospects for education andemployment, and ultimately improvement in the statusof women.■ Unintended pregnancies contribute to maternal morbidityand mortality; 27% of maternal deaths can be prevented bymeeting unmet need for family planning.■ HIV-related morbidity and mortality in a mother living withHIV impact critically upon her child’s survival.■Fewer unintended pregnancies mean fewer infants born tomothers living with HIV, thus resulting in a smaller numberof potentially HIV-positive infants.The principles upon which this framework is based are:1. Addressing structural determinants of HIV and sexual andreproductive ill-health2. Focusing on human rights and gender3. Promoting a coordinated and coherent response (i.e. theThree Ones Principle)4. Meaningfully involving people living with HIV (i.e. GIPAPrinciple)5. Fostering community participation by young people, keypopulations at higher risk, and the general community6. Reducing stigma and discrimination7. Recognizing the centrality of sexuality as an essentialelement in human life and in individual, family andcommunity well-being.It offers guidance to:1. Implement a package of services for preventing HIV andunintended pregnancies within stigma-free integrated SRHand HIV services2. Utilise key entry points to integrating services for HIVand SRH3. Strengthen national programme implementation, includingto deliver prong 1 and 2 interventions4. Carry out five key strategies:Strategy 1: Link SRH and HIV at the policy, systems andservice delivery levelsStrategy 2: Strengthen community engagementStrategy 3: Promote greater involvement of menStrategy 4: Engage organizations of people living with HIVStrategy 5: Ensure non-discriminatory service provision instigma-free settings.Preventing HIV and Unintended Pregnancies: Strategic Framework 2011–2015 2