Prevention of mother-to-child transmission
© UNICEF Cambodia/Nicolas Axelrod
Cambodian women are especially vulnerable to HIV, in part due to cultural norms that tolerate men who seek sex outside of marriage and return home to have unprotected sex with their wives. Although the country’s epidemic remains largely male-driven, it is increasingly infecting more women and children, sparking new urgency in the need to reshape Cambodia’s national response to the virus.
Although HIV prevalence among adults is relatively low in Cambodia (estimated at 0.8 per cent in 2010), it is higher among pregnant women, at 1.1 per cent in 2006. Only 56 percent of women and 34 per cent of men have comprehensive knowledge of mother-to-child transmission, according to the Cambodia Demographic and Health Survey 2010, revealing a critical gap in access to life-saving information.
That lack of information increases the odds for mothers to inadvertently pass the HIV virus onto their babies. Limited access to and low quality of health services mean that many expecting mothers do not receive the support they need to break the chain of HIV transfer within families. By the end of 2010, only 49 per cent of the estimated number of HIV-infected pregnant women received antiretroviral prophylaxis/treatment to protect their babies from the virus.
Prevention of mother-to-child transmission (PMTCT) initiatives combine HIV counselling and testing with antenatal care and education for pregnant women and their families, in addition to counselling on safe infant feeding practices and family planning. Timely referral for antiretroviral therapy also helps HIV-infected mothers cope with their illness and thrive, which in turn translates into better care for their babies. Without these interventions, 35 per cent of infants born to HIV-positive women will become infected with HIV each year, further impacting families. However, with appropriate services and care, this rate can fall to less than 5 per cent.
Thus, in 2010, with support from UNICEF, the national PMTCT guidelines were updated to include the newly revised World Health Organization recommendations on Antiretroviral Therapy for HIV Infection in Infants and Children. As a result, highly effective interventions are being rolled out nationally to improve the health of mothers, substantially decrease mother-to-child transmission and improve HIV-free child survival. This represents a significant shift towards achieving the virtual elimination of HIV in children in Cambodia.
Supporting the government and community based organizations to collaboratively provide parents with relevant knowledge, including knowledge of their HIV status, along with increasing their access to these highly effective interventions within the context of quality health and treatment services and psychosocial support, are central features of UNICEF’s work in HIV and AIDS.
© UNICEF Cambodia/Nicolas Axelrod
What we do
- With the National Centre for HIV/AIDS, Dermatology and Sexually Transmitted Diseases and the National Maternal and Child Health Centre, scale up the provision of quality, comprehensive PMTCT services to reach pregnant women, their partners and infants, particularly among high risk groups.
- Support the government to expand provider-initiated testing and counselling for pregnant women and their male partners and strengthen linkages from prevention to care and treatment.
- Promote routine family-centred testing once a family member is identified as HIV-positive in an effort to promote early diagnosis and timely access to care.
- Support the government to expand labour ward testing to other Phnom Penh (higher prevalence) areas where large numbers of pregnant women with unknown HIV status exist.
- Provide ongoing technical support through site assessment and monitoring visits to ensure that quality PMTCT services are effectively integrated in maternal and child health services.
- Strengthen community awareness and understanding of PMTCT to increase demand for PMTCT services through targeted social mobilization and communication interventions with a focus on high risk groups.
- Work with the government to ensure all (known) HIV-infected pregnant women and their HIV-exposed infants receive antiretroviral treatment/prophylaxis, treatment for opportunistic infections, breastfeeding education, and follow up to reduce mother-to-child transmission of HIV. Test and scale up cost effective measures that help to reduce loss to follow-up and improve treatment adherence for both mothers and infants.
- Assist with the widespread application of the newly revised national PMTCT Guidelines through training, supervision and onthe-job support, and strengthening of data monitoring systems.
- Strengthen PMTCT programme planning, management, coordination, implementation and supervision at all levels in order to reach PMTCT targets by 2015.
Fewer babies are being infected with HIV through their mothers as a result of more pregnant women accessing PMTCT services before giving birth and more health facilities offering HIV testing and counselling. Across the country, 921 health facilities (92 per cent) offered HIV counselling and testing to pregnant women attending antenatal care in 2010 in comparison to only 30 in 2005. As a result 230,725 expecting mothers were tested for HIV in 2010 – three times the number tested in 2008.