WHO’s four prong approach to PMTCT

I. Prevention of Primary HIV Infection

The ideal way of preventing children from HIV infection is the prevention of the parents from HIV infection. Decreasing the number of mothers who are becoming HIV-infected is the most effective way of reducing MTCT. Men should also be involved in primary prevention intervention. Primary prevention strategies include the following components.

a) Promote safer and responsible sexual behaviour and practices.

Safe and responsible sexual behaviour and practices include delaying the onset of sexual activity and practising abstinence for those who are trustworthy, reducing the number of sexual partners, and using condoms correctly and consistently for those already engaged in. In general, the "ABC" approach should be followed.

• A = Abstinence.
  
• B = Be faithful to one HIV-uninfected sexual partner.
  
• C = Condom use; use condoms correctly and consistently.
  

b) Provide access to condoms.

Condoms can prevent HIV transmission when used correctly and systematically, especially in high-risk settings. Clients should be provided with information on how to use condoms and be given the skills to negotiate for safer sex with their partner. Safer sex is anything that can be done to lower the risk of STIs/HIV and pregnancy without reducing pleasure.Ways to promote safer sex practices include:

• Incorporate health education on HIV in the formal school curriculum.
  
• Use community education and conversation and mobilise established groups (family, church, community).
  
• Design community messages appropriate for individuals at greatest risk.
  
• Assist individuals in making personal risk-reduction plan through HTC.
  
• Promote dual protection (condom) routinely during family planning counselling.
  
• Supply condoms to men, women, and adolescents in the community and as an integrated component of health care wherever possible (family planning, ANC, HTC, HIV/AIDS care, MCH, STI).
  
• Promote and provide female condoms.
  
• Encourage male involvement in HIV/AIDS prevention at all levels using locally acceptable and culturally sensitive approaches.
  

c) Provide early diagnosis and treatment of sexually transmitted infections.

The early diagnosis and treatment of STIs can reduce the incidence of HIV in the general population by about 40%. STI treatment services present an opportunity to provide information on HIV infection, the transmission including MTCT, and referral for testing and counselling. Male partners should be used to involve in STI screening and treatment in every opportunity.

d) Make HIV testing widely available.

HIV testing and counselling (HTC) services need to be provided to all women of childbearing age because PMTCT interventions depend on upon a woman knowing her status. Partner disclosure, referral and testing should be promoted for every woman being tested, be it negative or positive.