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Towards a Communication Strategy for the Prevention of Mother-to-Child Transmission of HIV/AIDS

The HIV/AIDS epidemic is resulting in an increasing number of infants becoming infected each year, and in many countries HIV/AIDS has become a major cause of infant and young child mortality. In light of this alarming situation, participants from 14 countries in Africa, Latin America and the Caribbean representing governments, NGOs and UN Agencies met in Gaborone, Botswana, from 27-31 March 2000. The objectives of the meeting were (a) to assess the present status of implemention of interventions for the Prevention of Mother-to-Child Transmission (PMTCT) of HIV, and (b) to propose appropriate actions. Since the PMTCT initiative was launched in 1998, it has become clear from the increasing scientific evidence and recent results from countries such as Botswana, Côte d'Ivoire, Rwanda, Uganda and Zimbabwe, that it is possible to make a difference.

The communication component of PMTCT is particularly crucial. In July 1998, a draft communication strategy for PMTCT was developed during a communication workshop facilitated by Neill McKee, at the time Regional Communication Advisor for ESARO. In July 2000, an updated PMTCT communication strategy was developed on the basis of lessons learned during the initial years of pilot programmes in PMTCT, and through specific information gathered from the Bostwana and Rwanda pilot programmes. This PMTCT communication strategy aims to set out some basic guidelines and suggestions that are universal for all countries engaging in PMTCT intervention activities. However, specific communication planning should be tailored to the specific needs of each country's unique setting and community situations. As stated in the original 1998 draft strategy outline, reducing MTCT is a complex challenge. It involves expanding HIV counselling and testing so that women who wish to know their status can do so with full confidentiality, and those who are HIV-negative can be helped to maintain their negative status. It calls for improving antenatal and delivery care. PMTCT also demands protection against possible stigma and rejection for women who find they are infected, and after counselling, decide not to breastfeed - a visible act in most developing countries, which in many cases now identifies a woman as HIV-postive. Alternative infant feeding options (such as home prepared or commercially prepared formula) must be made available and safely prepared. Given the importance of breastfeeding to infant health, but recognising the part breast milk September 2000-Issue 19 Contents 1 Towards a Communication Strategy for the Prevention of Mother-to-Child Transmission of HIV-AIDS 3 From the field 5 What's new? 13 Resources 20 Announcements 21 Training and Conferences plays in MTCT - UNICEF, WHO and the UNAIDS Secretariat recommend that appropriate alternatives to breastfeeding be made affordable and available when necessary to HIV-positive mothers who choose not to breastfeed, while efforts continue to promote breastfeeding for HIV-negative women and women of unknown status.

In terms of communication, some issues such as infant feeding, stigmatisation and male partners and community participation are extremely relevant to PMTCT. The issues surrounding infant feeding for PMTCT are complex and emotional. Enormous strides have been made globally in promoting breastfeeding. Knowing the risks of artificial feeding, health workers feel often uneasy about offering information on formula feeding and all other infant feeding options to HIV-positive mothers. It is important for countries to explore those infant feeding options that make the most sense to their context and customs, and are locally viable. Communication messages, materials and activities must walk a fine line in trying to de-stigmatise HIV and the associated use of any formula without being seen as promoting formula over breastfeeding for the general public. PMTCT communicators must be extremely aware of, and explore with the community, all aspects of stigmatisation surrounding breastfeeding and formula feeding. The aim is to develop balanced and appropriate communication messages that provide HIV-positive women (and their partners/family members) with information on all options available, the support that they can get from the existing services in implementing them, and therefore facilitate their informed choice. This needs to be accomplished while at the same time strengthening promotion of exclusive breastfeeding for untested and HIV-negative mothers, as well as for HIV-positive mothers who decide to breastfeed. The issue of stigmatisation, both in infant feeding and in knowing and making known one's HIV status, is a key point in the success of any PMTCT programmes.

It is imperative that social research, both qualitative and participatory, be employed at the onset of PMTCT projects, preferably during the programme design phase, to ensure that communication activities address the root causes of stigmatisation towards HIV-positive community members (including men, women and children), and identify the fundamental issues surrounding infant feeding options and support and care of HIV-positive parents and their children. While it is not uncommon to develop PMTCT programmes from the central level in an emergency response mode, it is critical that PMTCT communication staff take the time to engage in community-based research and dialogue to assess and determine the community's preparedness to deal with and support HIV-positive women and their children. Community participation is a key element in the success of PMTCT programmes. Communities can and should be included in the planning process from the programme design phase, and can provide a rich resource from which to build communication strategies and activities. Again, given the sensitive nature of PMTCT issues, it is important that communities are consulted throughout the programme design phase, and that this consultative process continues throughout the life of the programme and becomes institutionalised as an intrinsic part of the PMTCT interventions. As such, continued dialogue with participating communities will provide a constant pool of information from which communication specialists can refine and re-define communication messages, activities and support materials. From a communication perspective, PMTCT is a complex programme, not because of the actual service package, but rather because of the complex set of social and cultural issues that surround the suggested behaviour changes required of HIV-positive mothers and the communities in which they live. But PMTCT is also a powerful tool - an entry point to open up a discussion about HIV/AIDS within families, communities and among health staff. By engaging the communities, families and health staff as full partners in the development of communication interventions for PMTCT, and by utilising participatory research information, PMTCT teams can develop communication strategies that are dynamic, empowering, and that promote solutions tailored to the needs of local communities.