June 2007

Studies in Brief
India: Are PPTCT programs an entry point to other HIV and reproductive health services?

A young mother-to-be receives HIV pretest counseling at an antenatal clinic. Photo credit: Jyotsna Murthy

In India, an estimated 21 percent of the over 5 million people living with HIV are women of reproductive age. The national prevention of parent-to-child transmission program (PPTCT) looks to antenatal care (ANC) as an entry point to preventing HIV transmission from mother to child. But does the program also serve as an entry point to other key HIV and reproductive health services for HIV-infected mothers and their children? To explore the extent to which these services are linked, researchers from Horizons and two Indian NGOs conducted a study in three high prevalence states (Andhra Pradesh, Karnataka, and Manipur).

A total of 41 in-depth interviews and 268 structured interviews were held with HIV-positive pregnant and postpartum women (0–24 months post-delivery) who had received PPTCT services. In addition, 32 service providers and program managers of public sector and NGO-run PPTCT programs were interviewed.

When asked about their HIV testing experience, almost 70 percent of women interviewed said they were first tested during ANC. A very high proportion of the women’s husbands had also undergone HIV testing, generally after their status was detected.

Almost all of the women reported that their ANC providers informed them of medication they could take to reduce risk of HIV transmission to their child. A large majority of postpartum women reported taking the medication as recommended: 60 percent took Nevirapine and 21 percent were on AZT; one-tenth did not remember if they took any medicine. Among the women who did not take any medicine (8 percent), most indicated that it was because they had delivered at home and visited the clinic after giving birth. The vast majority of postpartum women (82 percent) reported that their babies had received syrup medication. Six percent reported that their infants did not receive the medication and 8 percent did not remember.

Only 42 percent of the youngest and second-youngest children of the 211 women with living children had been tested for HIV. The children of 20 of these women had tested HIV-positive and about half were informed about antiretroviral therapy (ART) for their child. Only two women reported that their child was currently on ART.

Among postpartum women, 87 percent did not want to have another child. However, among these women, only 44 percent reported using condoms and 6 percent reported having had a sterilization operation. Four out of ten women who did not want more children were not using any family planning method to prevent unintended pregnancies.

Although about 40 percent of the women were aware of treatment for HIV, only 18 percent mentioned that their PMTCT provider had informed them about it and only one-third were told about CD4 testing. Furthermore, only 7 percent of women were currently on ART and only two women stated that their PMTCT providers referred them to the treatment facility.

Results from this study indicate that HIV-positive women who are receiving services in an ANC setting have unmet needs for sexual and reproductive health care and treatment services. PPTCT programs need to understand these women’s fertility intentions and provide appropriate information on family planning methods. Also, despite the fact that free treatment is provided through the public sector, most of the women were not informed about treatment facilities or the need for CD4 testing. Linkages between PPTCT services and HIV care as well as family planning services need to be strengthened and providers need to be trained to make appropriate referrals to vital services.

A final report will be available in August 2007. For more information about this study, contact Vaishali Mahendra at vmahendra@popcouncil.org.

—Hena Khan

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© 2007 The Population Council, Inc.

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This page updated 6 July 2007

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