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‘Stepping Stones PLUS’ - HIV & safe motherhood

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08 May 2012

When Jane Awino suspected she was pregnant, she went to the local hospital for a check-up.  Her pregnancy was confirmed, and she was asked to bring her husband to the clinic, where HIV testing has been made routine.  Jane recalls:

“After much prodding, he agreed to accompany me, but he refused to be tested.  After the test, it turned out that I was positive.  When my husband heard about it, he just turned violent and beat me senseless, and chased me from the home, together with the children.”

Community elders attempted to save the marriage through mediation, but all their efforts were in vain. Jane and her five children now live with her mother.

This is a true story. It happened in Western Kenya, where a survey found that 95% of pregnant women did not disclose a positive HIV diagnosis to spouses and relatives for fear of stigma, discrimination and violence. Similar stories occur throughout the world. The fear of rejection, discrimination and violence prevents hundreds of thousands of HIV-positive women from accessing the health care they need to prevent passing HIV on to their children.  And every year, 370,000 children - mostly in sub-Saharan Africa - are born with HIV. 

In June 2011, world leaders met at the United Nations headquarters in New York to launch a global plan with an ambitious objective: to reduce the number of children born with HIV by 90% by the year 2015.  It is technically possible to achieve this objective.  Providing pregnant women living with HIV with antiretroviral medication and appropriate support helps them to have babies born free of HIV - and in safety for them both. With these measures in place, the likelihood of a child being born free of HIV can thus now be more than 95%.

Governments, UN agencies, private philanthropic organisations and international NGOs have the capacity to provide the financial resources and the technical know-how to produce an HIV-free generation. 

Yet many obstacles still block the path to achieving this objective. Chief among these are deeply entrenched, discriminatory attitudes, held at many levels, towards people living with HIV.  The stigma, discrimination and denial which still accompany HIV have the effect of deterring millions of women worldwide from accessing the simple, low-cost health services which would protect their unborn children and also keep them alive and safe.  These are issues which communities themselves also need to address.

A 140-page manual - ‘Stepping Stones PLUS’ - aims to support communities in tackling HIV-related stigma, discrimination and denial and promoting the care, respect and support for people with HIV which is the crucial missing ingredient.  Produced with support from UNICEF and three international NGOs, ‘Stepping Stones PLUS’ is a supplement to the internationally renowned ‘Stepping Stones’ training manual, published in 1995 by the Strategies for Hope Trust and ActionAid. 

Designed for use after groups have completed the original ‘Stepping Stones’ manual, ‘Stepping Stones PLUS’ contains new sessions and additional exercises for existing sessions.  Lead co-author, Dr Alice Welbourn, says:

“The contents are designed to promote a whole-community response to the epidemic through appropriate care and support and the involvement of people living with HIV in all aspects of programmes.  It will be particularly useful in working with community groups to support women with HIV in their quest to have babies born free of HIV, in safety for both mothers and their children.”   

Previously available only as a CD, ‘Stepping Stones PLUS’ has now been produced - in English and French - in printed form.  Selected pages can be viewed on the Strategies for Hope website:  To order copies, please contact TALC:;; tel.: +44 (0) 1727 853 869. 

For additional information about ‘Stepping Stones’, please contact  For all other enquiries, please contact the Series Editor, Strategies for Hope Trust: