1. Experiences from India XVI International AIDS Conference, Toronto
Does the PMTCT program facilitate access to HIV care and SRH services for HIV-positive women?
Experiences from India
Vaishali Sharma Mahendra, Avina Sarna, Naomi Rutenberg, Sucheta Panda, Rupa Mudoi, Archana Oinam, Venkat Pakkela,
Ashok Rau and L. Birendrajit Singh
XVI International AIDS Conference, Toronto
17 August 2006

2. Study partners Freedom Foundation, Bangalore and Hyderabad
Social Awareness Service Organization (SASO), Imphal
UNICEF India, New Delhi
UNIFEM South Asia Regional Office, New Delhi

3. Rationale
In India, 21% of the 5.1 million HIV-infected people are women of reproductive age.
Increased need for treatment and care as well as sexual and reproductive health (SRH) care.
National PMTCT program (referred as PPTCT) first to reach HIV-positive women with prevention services by using antenatal care (ANC) as an effective entry point.
PMTCT conceptualized as a multi-prong approach including prevention, treatment, and care, but focus has been on prevention.
Result is a cohort of HIV-infected women with poor access to HIV treatment and care and SRH services.

4. Research aim
To explore if the PMTCT program serves as an entry point to SRH services and HIV treatment and care for HIV-positive mothers and their children.

5. Research design Cross-sectional study design Study sites:
Andhra Pradesh, Karnataka, and Manipur (high prevalence states)
15 PMTCT sites including government and private sector sites where NGOs are providing services as well as stand-alone government sites

6. Research methods In depth interviews with: Structured interviews
40 purposively selected HIV-positive women (pregnant and postpartum)
30 service providers and program managers of public sector and NGO PMTCT programs
Structured interviews
268 randomly selected HIV-positive pregnant (n=97) and postpartum women (0-24 months post-delivery; n=171)

7. Interim Results

8. Profile of respondents
Respondents had a mean age of 25 (range years).
Majority (89%) currently married; one-tenth widowed or separated.
Over half had one child and one-fourth had 2-4 children.
Over two-thirds had more than six years of education.
71% unemployed, almost half left job due to lack of child care, pregnancy, or illness.

9. HIV testing and disclosure
56% of the women diagnosed HIV-positive less than a year ago.
70% first tested while accessing ANC services.
Almost 80% disclosed their status to their husband.
90% reported that their husbands were tested for HIV:
70% said their husbands were tested after their status was detected
81% reported that their husbands were HIV-positive

10. Linkages with HIV treatment
Overall, 41% of the women were aware of ARV treatment.
Asked specifically about HIV treatment information provided during ANC:
30% were informed about CD4 testing
13% were informed about ARV treatment
Of all women, only 7% (n=19) were currently on ART:
Only 2 women were referred by their PMTCT provider
Majority mentioned NGO HIV care provider as link to HIV services

11. Linkages with pediatric HIV care
Among women with living children (n=211), 55% (117 women) reported having tested one or more of their children (165 children) for HIV.
Of these 117 women, 21% reported one or more child tested HIV-positive (of 165 children tested, 27 children (16%) were HIV-positive).
About half of the women with an HIV-positive child were informed about pediatric ARV therapy, but only two women reported that their child was currently on ARVs.
Lack of complete information about the government ARV program cited as a major reason for poor access to ARVs for children.

12. Linkages with SRH services
After learning their HIV-positive status, 27% of the women had one pregnancy and 7% reported 2-4 pregnancies:
43% of these women said their recent or current pregnancy was not planned
Half of these women had considered ending their pregnancy because they did not want to transmit HIV to their child or because their provider advised them to
One-fifth had terminated their pregnancy

13. Linkages with SRH services
The majority (87%) of respondents did not want to have more children:
Main reason was concern about their children’s future
Among postpartum women not wanting more children (n=149):
53% reported using condoms
6% had undergone sterilization
2% reported using other methods such as pill and IUD
About a third of women using condoms received them from their PMTCT service providers.
The majority of women who had undergone sterilization were advised of the method by their PMTCT providers.

14. Summing it up
Preliminary analysis indicates that linkages between PMTCT programs and HIV treatment and care services is weak.
SRH services are narrowly focused on fertility control—contraceptive provision and termination of pregnancy services.
Failure to address the SRH needs of women and to connect them to HIV treatment and care is a shortcoming of the PMTCT program.
Study results will be used by UNICEF, UNIFEM, and NACO to strengthen linkages between PMTCT and other services vital to HIV-positive women and their families.