This initiative draws on face-to-face communication, as well as printed materials, to improve providers' skills in counselling and interpersonal communication and to educate HIV-positive and -negative women and their partners. Social mobilisation is another key strategy, reflected by activities to strengthen community-based support for PMTCT and to combat HIV-related stigma. Underpinning all aspects of the project is an effort to ensure the participation of people living with HIV and AIDS.

Specifically, the project was shaped by a participatory research process. PATH began by administering a knowledge, attitudes, and practices (KAP) survey to 517 obstetrician-gynaecologists and midwives in southern Ukraine. (The report revealed major gaps in providers' knowledge of HIV/AIDS and PMTCT). The team also conducted focus group discussions (FGDs) with 27 HIV-positive mothers who had delivered babies in the previous 2 years. (These women reported that HIV-related stigma and discrimination were widespread, particularly at maternity homes; that voluntary counselling and testing (VCT) was unavailable at antenatal
care clinics and maternity homes; and that providers frequently violated confidentiality.)

Based on this research, organisers designed training sessions emphasising VCT as a key entry point to prevention information and personal risk assessment; these sessions are being offered to chief doctors, department heads, obstetrician/gynaecologists, and midwives. Partner organisations participate in the trainings, presenting their own initiatives for VCT and supportive counselling. The project is also providing technical assistance for a VCT supervision system, and is strengthening facility capacity to integrate PMTCT into maternal and child health services. In addition, the team has developed a training curriculum that is being incorporated into medical education at various local institutions.

Based on the belief that community-based psychosocial support is important for HIV-positive individuals, PATH is working to increase the availability, accessibility, and use of community-based support groups for HIV-positive pregnant women and mothers. For instance, the team is establishing self-sustaining peer-support programmes that offer newly diagnosed women counselling and support. Through collaboration with the leaders of these groups and with local partners, PATH developed (following pre-testing) various materials and messages for outreach to vulnerable women, especially sex workers and injection drug users. The team has also designed and produced a brochure for pregnant women explaining the benefits of VCT and highlighting their right to this service.

HIV/AIDS, Women.

PATH indicates that, in 2004, there were nearly 2,300 cases of MTCT in the Ukraine, reflecting an increase of 25% over the previous year. Women there now account for about 40% of known HIV infections. In 2004, the rate of HIV transmission from mothers to infants was estimated to be 8.4%.