HIV is one of the most infectious diseases with more than 25 million deaths in the last 30 years. In 2012, there were more than 34 million people who were HIV positive. The disease can be suppressed with combination antiretroviral therapy consisting of three or more antiretroviral drugs. This mode of treatment does not cure the infection but staves off the viral replication allowing the infected person’s body to strengthen its immune body to combat infections.

Untreated HIV infection can contribute to increased diseases and even the early demise of the mother. HIV infection in adolescent girls and women can be prevented with education and behaviour change. This will increase HIV awareness and reduce unsafe sexual behaviours.

Women living with HIV tend to have poor health and will need lifelong antiretroviral therapy along with appropriate family planning. Prevention of mother-to-child transmission (PMTCT) programmes have been adopted by countries around the world. The four-step approach to PMTCT emphasizes prevention of new infections and provision of essential care and treatment to people living with HIV.

• preventing new HIV infections in women
• preventing unwanted pregnancies in women living with HIV
• preventing mother-to-child transmission in women living with HIV

Health problems	Issues to maternal health	Issues to infant health
HIV infection in adolescents, women and their sexual partners/spouses	Untreated HIV infection can contribute to increased maternal mortality and morbidity (related to childbirth) and progresses to HIV-related premature illnesses and death.	Untreated HIV infection progresses to HIV-related illnesses and death in the mother, which leads to orphanhood (major risk factor for poor child health and social outcome); untreated HIV infection in the mother leads to a high risk (up to 35%) of transmission of HIV from the mother to the newborn child, resulting in chronic and fatal illness in the child.

Health problems	Preventive interventions	Delivery mechanisms
HIV infection in adolescent girls and women.	Education and behaviour change to increase HIV awareness and reduce unsafe sexual behaviours; delay sexual debut; promote risk reduction, especially safe sex and dual method birth control (with condoms) and STI control; increase awareness of HIV, HIV status and risk through provider-initiated HIV counselling and testing, including male partner testing; new approaches of antiretroviral therapy for prevention and potentially pre-exposure prophylaxis; maximize access to antiretroviral therapy for people living with HIV in need of treatment; male circumcision (decreases acquisition of infection in men, secondarily decreasing onward horizontal transmission to female partners).	Primary care facilities; community settings; family planning programmes, male circumcision programmes; mass media.
Risk of transmitting HIV from mother to child	Preventing unintended pregnancies in general and specifically in women living with HIV; family planning/interventions to avoid unwanted pregnancies; provide effective PMTCT prophylaxis for women not eligible for or not on antiretroviral therapy; ensure linkages to future HIV care and treatment.	Primary care facilities; referral facilities/ specialized services; PMTCT programmes.
Risk of transmitting HIV from mother to child.	Provision of antiretroviral therapy for women living with HIV who need treatment; assure supply of antiretroviral medicines; lifelong treatment for eligible women living with HIV.	Primary care facilities; referral facilities/ specialized services; antiretroviral treatment programmes.
Risk of transmitting HIV from mother to child.	Retesting for HIV during pregnancy or breastfeeding to detect sero conversion (new infections).	HIV retesting programmes in high incidence settings1.
Poor health in women living with HIV.	Retaining in HIV care and treatment programmes; determining eligibility for lifelong antiretroviral therapy; providing antiretroviral therapy if/when eligible; providing HIV basic care package; ensuring appropriate family planning.	Primary care facilities; referral facilities/ specialized services; linkage between maternal and child health and HIV treatment/care programmes.