Transcript Slide 1

Mobilizing for Reproductive
Health/HIV Integration
Reducing HIV
Vulnerability and Impact
for Women, Young
Women & Girls
Addis Ababa, 26 - 29 February 2008
Lynn Collins, UNFPA
Based on collaborative work with EngenderHealth, GCWA, IPPF,
YoungPositives, ICW, GNP+, IWHC, PopCouncil, WHO, UNICEF
Key Links – Priority Framework
Assessing priority linkages
• No ‘one size fits all’ model for linkages/integration
• Linkages are bi-directional
• Policy, systems, and service delivery considerations
• Less commonly considered as linkage policies and programmes are those addressing the
structural determinants, particularly gender inequality
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Gender-based violence
Economic empowerment of women
Child marriage
Legal/Policy barriers
SRH Access
Participation and Rights
Young Women and Girls:
Vulnerability to HIV and Limits to Impact Mitigation
• Lack of economic
opportunity
• Gender based
violence/Coerced sex
• Biological susceptibility
• Lack of knowledge
• Femininity stereotypes
• Lack of empowerment
• Lack of access to sexual
& reproductive health
services &
commodities
• Lower levels of
education
• Inability to
negotiate terms of
sexual relations
• Trafficking
• Inability to exercise
rights
• Harmful traditional
practices
• Lower status
• Child marriage and
early pregnancy
Know Your Epidemic – e.g. Report Cards
• “Know Your Epidemic”
• Inherent Complexity
• Report Cards: HIV
Prevention for Girls and
Young Women
Covers legal, policy, availability,
access, participation and rights
aspects of HIV prevention
strategies and services
(23 countries, including Cameroon,
Ethiopia, Mozambique, Nigeria)
http://www.unfpa.org/publications/detail.cfm?ID=315&filterListType=1
2005 Country Progress toward UNGASS Declaration
of Commitment 2001 Targets
Percentage of youth aged 15-24 who correctly
identify ways of preventing HIV transmission
and who reject major misconceptions about HIV
transmission
2005 Global Target 90%
Global Results 2005
Male 33%
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Female 20%
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Paragraph 26 of the Political Declaration on HIV/AIDS 2006
“We, Heads of State and Government and
representatives of States and Governments…Commit
ourselves to addressing the rising rates of HIV infection
among young people to ensure an HIV-free future
generation through the implementation of
comprehensive, evidence-based prevention strategies
responsible sexual behaviour, including the use of
condoms, evidence- and skills-based, youth specific
HIV education, mass media interventions, and the
provision of youth friendly health services.”
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Sexuality education leads to safer sexual
behaviour
• Strong evidence that school-based
sexual health /HIV education does not
encourage increased sexual activity.
• Quality sexual health education
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delayed onset of sexual activity
reduced # sexual partners
reduce frequency of sexual activity
increased use of condoms
• Responsible & safe behaviour can be
learned.
• Sexual health education is best started
before the onset of sexual activity.
Evidence-informed Interventions for
Young People
Interventions graded as 'GO!' and 'Ready' for wide-spread implementation include:
In schools: Curriculum-based interventions, led by adults, that are based on defined
quality criteria, can have an impact on knowledge, skills and behaviour
In health services: Increasing young people's use of services by training service
providers, ensuring that facilities are 'adolescent-friendly' and creating demand
through community support
In the mass media: Behaviour change communications that employ a range of media
and build on principles of good practice
In communities: Working through existing organizations and stuctures to reach young
people with interventions tailored to them.
For young people most at-risk: Interventions that provide information and services to
key groups through static and outreach facilities
http://www.unfpa.org/publications/detail.cfm?ID=305&filterListType=1
Work in Progress
 IPPF, UNFPA, WHO, and other partners, in consultation with the
Cochrane Review Group, are conducting a systematic review of the
linkages evidence
 Purpose - identify, summarise and determine quality: a) rigorous
evaluation research; b) promising practices
 Which linkages will have the greatest impact and under what
circumstances?
 Are linkages cost effective?
 How best to strengthen selected linkages in different programme
settings?
 How is availability, uptake and quality affected?
 Outcome measures:
 HIV and SRH-related
 Individual and programme-level
Cost effectiveness of family
planning
Stover et al, 2003 Adding family planning to ongoing services for the
prevention of vertical transmission of HIV in 14 high-prevalence
countries could double the number of HIV-positive births averted, in
addition to saving women’s lives and averting children’s deaths.
Sweat et al. 2004 Small reductions in maternal HIV prevalence or in
unintended pregnancy among women with HIV had an impact on HIV
incidence in infants which was equivalent to that of ARV intervention
with nevirapine based on modeling in 8 countries in Africa.
Reynolds et al, 2005 Family planning services in sub-Saharan Africa are
preventing HIV infection in more infants than is the provision of
nevirapine.
Reynolds et al, 2006 –
Expenditure of US$ 45 000 to increase
contraceptive services would prevent 88 HIV-positive births, whereas,
for the same cost, the promotion and provision of nevirapine in
antenatal care would prevent only 68 such births
Summary of evidence for comprehensive PMTCT
• Element 3 alone has a limited impact in resource-poor settings
• Small reductions in maternal HIV prevalence or in unintended
pregnancy among women with HIV have an impact on HIV
incidence in children equivalent to ARV intervention
• Family planning more cost effective than nevirapine
• Adding family planning to ongoing services (VCT, ARV) can double
the number of HIV positive births averted
• Conclusion: UNGASS goals on reduction of HIV infection in infants
cannot be met through current focus on element 3 alone