THE ROLE OF Psychosocial support iN PMTCT

1. THE ROLE OF Psychosocial support iN PMTCT EGPAF Satellite � 6th IAS Conference: Rome, 17-20 July 2011 By Dr. Tapfuma Murove With support from Noreen Huni

2. Who are we?

3. PSS is support for emotional and social aspects of children�s lives Girls and boys exposed to devastating effects of HIV & AIDS are especially in need of care for their emotional and social well being Pregnancy and child bearing is a family and not an individual issue Expecting parents, especially mothers living with HIV & AIDS also face emotional and social challenges related to issues of disclosure, stigma, cultural practices, social exclusion & violence These challenges affect PSS well-being and highlight the need for PSS in promoting PMTC T in communities Family and community support is critical for PSS well-being WHAT IS PSYCHOSOCIAL SUPPORT? (PSS) In most African families, pregnancy and child bearing is a family and not an individual issue. This has implications on how the family and the community at large relate with the challenges posed by HIV in pegnancy. In most African families, pregnancy and child bearing is a family and not an individual issue. This has implications on how the family and the community at large relate with the challenges posed by HIV in pegnancy.

4. REPSSI tool: Are We Making a Difference helps monitor PSS mainstreaming among implementing partners; 3 broad outcomes are: Skills and knowledge: competencies & capacities to cope with life�s demands, stressful situations and managing relationships (problem solving, decision making, negotiation) Emotional well-being: ability to know and manage oneself, self awareness, self worth, feeling safe & happy, purpose & hope (intrapersonal) Social well-being: ability to interact with others, quality of social interaction, having relationships & social support networks, social connectedness, sense of belonging & ability to communicate (interpersonal) Key lesson in applying this tool across programmes is that social and emotional well being is difficult to monitor and measure. This is an area for further research WhAT ARE PSS OUTCOMES?

5. In all programmes (Health, Nutrition, Education, etc), include psychosocial support � Review HOW we programme! This approach: Acknowledges that PSS has a role across sectors PSS is an integral part of PMTCT Community prevention, care and support programmes should include PSS A successful approach: Mainstreaming PSS � � � �

6. Information and knowledge on PSS issues in PMTCT (Mainstreaming PSS within Paediatric HIV & AIDS Treatment) Community mobilization for PSS in prevention, care and treatment (Journey of Life Tool in Kenya & Botswana) Peer education & support to pregnant and new mothers; mentor training on HIV & AIDS basics, disclosure safer infant feeding and positive living (Talking Book, Safe Disclosure to Children with HIV & AIDS � South Africa) Counselling services linked to VCT & male involvement (KORDP Kenya) Promoting sexual and reproductive health services (Training on adolescent Sexual Reproductive Health and Rights) What community programmes are doing

7. Pregnancy results in emotional changes, depression, anxiety and at times suicidal tendencies - based on physiological, social & economic pregnancy related circumstances. Deciding to fall pregnant and being pregnant while HIV positive creates emotional and social challenges � uncertain of pregnancy outcome. Discovering HIV+ve status � fear, blame, shame, stigma & discrimination. Limited male involvement during pregnancy and at delivery Health infrastructure and facilities may limit male involvement during delivery Culture, men & women socialisation towards pregnancy & delivery, health worker attitudes, etc Culture, family and involvement of men influence feeding practices PSS issues in pmtct

8. Enhances one�s ability and assertiveness to access prevention, treatment, care & support services (before, during and after pregnancy). Emotional and social wellbeing reduces stress and depression; improved mother-baby interactions. Family and community social support increases adherence to treatment, facilitates disclosure Skills and knowledge + options = informed feeding choices & adherence to decision despite associated social and emotional challenges Emotional wellbeing enables mothers to provide better care Social + emotional support = happy, safe & thriving children Therefore PSS contributes to positive PMTCT outcomes Interplay between pss and pmtct outcomes:

9. Limited role of families & communities in providing PSS Role of the traditional birth attendants Health workers inadequate training & resources in PSS Linking PMTCT to child & HIV sensitive social protection Mainstreaming PSS into Sexual Reproductive Health & Rights Community programmes that promote male involvement Balancing impact and reach in delivery of PMTCT programmes Social workforce capacity strengthening - family, community & referral to formal services (early referral for testing, treatment, etc) Evidence and improved data use Gaps in programmes: FIELD EXPERIENCE

10. Policy harmonization (PMTCT, prevention, treatment, care & support) Aligning policy to programmes Mainstreaming PSS into national health and HIV and AIDS plans and frameworks Clear and consistent advocacy messages Mainstreaming PSS into prevention, treatment, care & support Access to treatment and support services Structural barriers to male involvement Community awareness and mobilisation Policy and advocacy ISSUES IN PMTCT

11. Strengthen social service workforce to deliver PSS Develop culturally appropriate PSS tools & interventions Create enabling policies and environment for holistic PMTCT Strengthen PSS within sexual reproductive health and rights Increase information and capacities of communities to care Promote male involvement Counselling and support services at community level RECOMMENDATIONS

12. Personal & Professional Development Human Rights Based Approaches & Child Protection Child and Youth Development Care and Support of Children at Risk Integrated Development in Communities Service Learning Project What are capacity gaps in pediatric care and PMTCT that require innovative skills building? REPSSI and UNICEF developed the learning modules Supported Situated Distance Learning Certificate Course in Community Based Work with Vulnerable Children and Youth� �The programme changed my perception and understanding about children�s work! ...it is a profession with legal and ethical repercussions. There are theories and principles to follow which make it systematic hence it�s a profession� Certificate participant, Tanzania. 4 workshops for each module designed to: focus students on key trends, theories and approaches share students� experiences in relation to new concepts in study materials Students complete 2 assessed assignments for each module on: Understanding of new theories that may challenge old understanding Capacity to reflect upon experience and incorporate new theories into practice Recognition and value of experience working with children, youth and communities. REPSSI and UNICEF developed the learning modules Supported Situated Distance Learning Certificate Course in Community Based Work with Vulnerable Children and Youth� �The programme changed my perception and understanding about children�s work! ...it is a profession with legal and ethical repercussions. There are theories and principles to follow which make it systematic hence it�s a profession� Certificate participant, Tanzania. 4 workshops for each module designed to: focus students on key trends, theories and approaches share students� experiences in relation to new concepts in study materials Students complete 2 assessed assignments for each module on: Understanding of new theories that may challenge old understanding Capacity to reflect upon experience and incorporate new theories into practice Recognition and value of experience working with children, youth and communities.

13. Thank You