Transcript Slide 1

Overview of the SRH and HIV
Linkage
Dr. Jean-Baptiste ROUNGOU
WHO Regional Office for Africa
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Outline
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Rationale for linking SRH and HIV
What has been done so far?
What can be done to foster linkages?
Challenges
Key recommendations
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What do we mean by SRH and HIV
linkages?
This is the fostering of synergies in policy,
programmes, service delivery and
advocacy between sexual and
reproductive health and HIV. It refers to a
broader human rights based approach, of
which service integration is a subset.
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Rationale for Linking SRH & HIV
 Majority of HIV infections in sub-Saharan Africa are
 sexually transmitted, or
 associated with pregnancy, childbirth & breastfeeding
 among women
 Common root causes
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Poverty
Gender inequality
Gender-based violence
Human rights violations
Marginalization of key populations
Stigma and discrimination
Source: Sexual and Reproductive Health & HIV/AIDS: A Framework for Priority Linkages, WHO,
IPPF, UNAIDS, & UNFPA, 2005
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Benefits of Linkages
 improved access to and
uptake of key HIV and
SRH services
 better access of PLHIV to
SRH services tailored to
their needs
 reduction in HIV–related
stigma and discrimination
 improved coverage of
underserved / vulnerable /
key populations
 greater support for dual
protection
 improved quality of care
 decreased duplication of
efforts and competition for
scarce resources
 better understanding and
protection of individuals’
rights
 mutually reinforcing
complementarities in legal
and policy frameworks
 enhanced programme
effectiveness and efficiency
 better utilization of scarce
human resources for health
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations,
IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009.
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What has been done so far?
Political Commitment (Glion 2004, New York 2004)
Framework for priority linkages (2005)
Evidence Review (2008)
Rapid Assessment Tool for SRH and HIV linkage is
available (2008)
Indicators to measure linkages have been developed
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Conceptual Framework
Source: Sexual and Reproductive Health & HIV/AIDS: A Framework for Priority Linkages, WHO, IPPF,
UNAIDS, & UNFPA, 2005.
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What can be done?
SRH Providers should
 Provide HIV prevention information and services to all clients;
 Provide information to prevent unintended pregnancies and HIV/STIs
through correct and consistent condom use;
 Provide nondirective, nonjudgmental and confidential counselling on
SRH of people living with HIV;
 Provide HIV counselling and testing and ART as indicated;
 Strengthen maternal and child health services
 Deliver a comprehensive package of PMTCT services
 Address the SRH needs of key populations and their clients.
Source: Gateways to Integration Case Studies for Haiti, Kenya and Serbia, WHO, UNFPA, UNAIDS,
IPPF, 2008.
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What can be done?
HIV service providers should
 Address sexual and reproductive health of people living with HIV
 Prevent, diagnose and treat sexually transmitted infections other
than HIV;
 Refer for prenatal care and high quality obstetrical services;
 Provide counselling on fertility desires and provide related services
and commodities;
 Better understand and respond to the SRH needs of key
populations, including men who have sex with men, people who use
drugs, and sex workers and their clients.
Source: Gateways to Integration Case Studies for Haiti, Kenya and Serbia, WHO, UNFPA, UNAIDS, 9
IPPF, 2008.
Challenges
• Discrepancies in policies
• Political commitments for linkages not
translated fully into action
• Lack of joint planning, funding leading to
vertical implementation
• Service providers lack skills to provide
integrated services
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Key Recommendations:
Policy Makers
 Develop, adopt, adapt and strengthen relevant policies,
HIV and SRH strategic plans and coordination
mechanisms to foster effective linkages.
 Advocate for sufficient funding for service delivery,
operations research and other activities to further the
linkages agenda.
 Ensure the implementation of a collective approach to
SRH and HIV linkages
 Promulgate and enforce legal frameworks
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations,11
IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009.
Key Recommendations:
Programme Managers
Strengthen linked SRH and HIV responses in both
directions through:
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Sustained government and stakeholder commitment
Adequate human resources and joint planning
Health provider training
Client education
Improved quality of services
Adequate infrastructure
Reliable supplies management
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations,
IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009.
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Key Recommendations:
Researchers
 Design studies on integrated SRH and HIV services and
document best practices.
 Evaluate key outcomes, such as:
 Health, Stigma reduction, Cost-effectiveness
 Trends in access to services
 Direct research toward areas that are under-studied and
innovative service delivery for universal access
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations,
IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009.
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