Transcript Slide 1

Mobilizing for RH/HIV Integration
Addis Ababa, Ethiopia
Session on Technical Issues and
Intersections
Wednesday, February 26, 2008
Relevant Components of GF Proposals
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Prevention
Treatment
Care and Support
Health systems strengthening
Gender
Vulnerable populations
M&E indicators
Entry Points for SRH in GF Service Areas and M&E
•HIV/AIDS
•Care &
•Support
•For chronically ill
•OVC
•Treatment
•BCC
•Condom
•VCT
•PMTCT
•ARV
•OI
•Supportive
•Environment
What are the
entry points
for SRH in
the GF
HIV/AIDS
Service
Delivery
Areas?
•Prevention
•Increasing
‘Coverage’
•Policy
development
•Strengthening CS
and HS
•Stigma reduction
•Key
indicators
•Increased
•people
reached
•Increased
•service
points
•supported
•Increased
people
trained to
deliver
services
•GP/012207/2
CCM Guidelines for Prioritized Integration
Services/programs
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STI
VCT
PMTCT
ART
Adolescent programs
Vulnerable populations
Gender-based violence
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Procurement
Policy and operational barriers
Matrix: GF Proposal Components and SRH Entry points
Components for
GF
SRH links
Prevention
Care and
support
Treatment
HSS
Gender
M&E
STI
X
X
VCT
X
X
PMTCT
X
X
Adolescent
X
X
X
X
X
Vulnerable
Populations
X
X
X
X
X
GBV
X
X
X
X
X
X
X
Procurement
X
X
Policy and
operational
barriers
X
X
Overarching
Activities for all
Entry Points
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STI
VCT
PMTCT
ART
Adolescent programs
Vulnerable populations
Gender-based violence
 Capacity building to ensure all
relevant providers can offer
integrated services
 Advocacy for commitments and
resource allocations, and
procurement for supplies
 Adding indicators to track
integrated services in M&E
systems
 Address gender issues
 Address policy and operational
barriers
Thank you
Other Entry Points for Integration
Follow from the Other Presenters
Scaling up What
Works – in VCT
Evidence
Knowledge of status is an
entry to other services;
most don’t know their
status
Illustrative services:
Promote VCT in all relevant service sites
Counsel HIV- on safer sex
Offer VCT to all pregnant women
Encourage couples with infant loss for VCT
Information on dual protection/method use
Promote couples VCT, discussion of STI,
pregnancy prevention
ART in SRH settings or referrals to ART
Promote VCT for adolescents and
vulnerable groups and ensure appropriate
services
Ensure VCT for rape victims and provide
PEP
Promote programs to destigmatize HIV
Scaling up What
Works – in STI
Evidence
STI (b. vaginosis) can
double women’s
susceptibility to HIV
Illustrative Services:
Point-of-care diagnosis/treatment of
STI
VCT or referral
Education on dual protection/dual
method use
Provide male/female condoms
Safer sex campaigns
Increase access to prevention
information Increase access to young
people and vulnerable populations
Ensure access to all related services
Illustrative services:
Scaling up What
Works – in
PMTCT
Evidence
Preventing HIV in
women and preventing
unintended pregnancy
are key elements in
PMTCT.
Provide information about HIV transmission
modes and protection
Ensure access for all clients to the management
of STIs, TB, Hepatitis and malaria
Promote protection against both HIV
transmission and unintended pregnancy
Ensure access for men and women to FP
information and services in PMTCT+ and VCT
Improve antenatal VCT programmes
Promote couples VCT
Ensure that male and female condoms are
available in all sites
Include / link PMTCT+ with all relevant services
Provide antenatal syphilis screening and
treatment in PMTCT+
Support community engagement on PMTCT+
Provide women living with HIV with ongoing
counselling and services, including the range of
options on pregnancy
Scaling up What
Works – in ART
Evidence
People on ART are
sexually active and want
access to contraception
and other services
where they receive ART.
Illustrative services:
Provide effective referrals for ART in VCT in
SRH settings
Provide ART and monitoring within SRH
settings, if feasible
Integrate guidance on ART side effects and
adherence with SRH services
Integrate SRH-related information and
services, including provision of
contraceptives, within ART programmes
Illustrative services:
Scaling up What
Works – for
Adolescents
Evidence
In countries with high
HIV prevalence, young
people, especially girls,
are at particular risk of
HIV.
Organize SRH and all relevant facilities to
make them accessible, welcoming,
appropriate and affordable for adolescents,
including OVC
Promote partnerships with and referrals to
other service providers.
Develop age appropriate health
communication and BCC programmes with
information on preventing
HIV and unintended pregnancy and positive
prevention
Promote adolescent VCT
Provide access for all adolescents to STI,
HIV and contraceptive information and
services
Address gender dimensions with
adolescents, including GBV, same sex sex
Illustrative services:
Scaling up What
Works – for
Adolescents,
continued
Evidence
In countries with high
HIV prevalence, young
people, especially girls,
are at particular risk of
HIV.
Develop school and community-based life
skills-building programmes for young
people
Support whole-of-community site
interventions
Support gender-based violence outreach
and training for boys that addresses gender
norms and life skills
Provide post-rape care
Support in- and out- of school peer
education programmes
Provide or refer to tuberculosis, hepatitis C
and drug treatment services
Ensure equitable access for HIV-positive
adolescents to ART
Increase skilled attendance at birth for
adolescents to reduce obstetric fistula
Scaling up What
Works – for
Vulnerable
Populations
(IDU)
Evidence
Injecting drug-related
epidemics do not
remain limited to IDU.
Illustrative services:
Organize SRH and all relevant facilities to make
them accessible, welcoming, appropriate and
affordable for IDU
Promote partnerships with and referrals to other
service providers.
Support safer-sex campaigns and information
about HIV transmission modes for IDU
Undertake community-based research with drug
users
Ensure that VCT programmes provide VCT
services to IDU
Integrate SRH and VCT into other programs for
IDU
Support behaviour-change interventions,
including information on positive prevention and
protecting against HIV and unintended pregnancy
Support peer education and outreach programs
with drug users
Scaling up What
Works – for
Vulnerable
Populations
(IDU)
Evidence
Injecting drug-related
epidemics do not
remain limited to IDU.
Illustrative services:
Provide clean needle and syringe distribution or
exchange, or referral to these services
Provide referral to opioid substitution therapy
programmes
Provide primary health care, such as hepatitis B
vaccination and vein care
Provide or refer drug users living with HIV to ART,
OI, and care and support programmes
Ensure equitable access for HIV-positive injecting
drug users to ART
Ensure that pregnant HIV-positive injecting drug
users have access to PMTCT+ programmes
Provide (or refer to) services for the diagnosis
and treatment of STIs, tuberculosis, malaria and
hepatitis C, when indicated, and treatment for
drug dependency
Institute demand-reduction activities
Support the empowerment of drug users
Illustrative services:
Scaling up What
Works – for
Vulnerable
Populations
(Sex Workers)
Evidence
Sex work and
transactional sex have
become increasingly
important in many
countries’ HIV/AIDS
epidemics.
Organize SRH and all relevant facilities to make
them accessible, welcoming, appropriate and
affordable for sex workers
Promote partnerships with and referrals to other
service providers.
Support safer sexual behaviours for sex workers,
partners and clients
Support safer-sex campaigns and information
about HIV transmission modes for sex workers
Undertake community-based research with sex
workers
Provide sex workers with information and
contraceptive services, including efficacy rates
for pregnancy prevention and use with HIV drugs
Provide primary point-of-care comprehensive
diagnosis and treatment of STIs, including
screening and treatment for syphilis, access to
commodities, such as male and female condoms
and lubricants, and VCT
Scaling up What
Works – for
Vulnerable
Populations
(Sex Workers),
continued
Evidence
Sex work and transactional
sex have become
increasingly important in
many countries’ HIV/AIDS
epidemics.
Illustrative services:
Assess the use of presumptive antibiotic
treatment of sex workers
Support peer education and outreach programs
with sex workers, including gender-based
violence and referrals to health, social and legal
services
Integrate the SRH needs of sex workers into
existing services
Provide referrals to all relevant treatment
services
Ensure that pregnant HIV-positive sex workers
have access to PMTCT+
Provide or refer sex workers living with HIV to
ART, OI, and care and support programmes
Ensure equitable access for HIV-positive sex
workers to ART
Institute rights-based programmes to prevent
entry into sex work
Support the empowerment of sex workers
Scaling up What
Works – for
Vulnerable
Populations
(MSM)
Evidence
Sex between men is
significant because it can
involve anal sex, which if
unprotected, carries a very
high risk of HIV
transmission.
Illustrative services:
Organize SRH and all relevant facilities to make
them accessible, welcoming, appropriate and
affordable for MSM
Promote the targeted and general use of highquality condoms and water-based lubricants, and
ensure their continuing availability
Support safer-sex campaigns and information
about HIV transmission modes for MSM
Support peer education and outreach programs
with MSM
Promote sexuality education, which includes
respect for sexual diversity, gender equality and
gender identity
Provide (or refer to) services such as VCT, STI
management, tuberculosis and hepatitis C care,
harm reduction and drug treatment
Provide or refer MSM with HIV to ART, OI, and
care and support programmes
Scaling up What
Works – for
Vulnerable
Populations
(MSM)
Evidence
Sex between men is
significant because it can
involve anal sex, which if
unprotected, carries a very
high risk of HIV
transmission.
Illustrative services:
Ensure equitable access for HIV-positive MSM to
ART
Provide education, outreach and information
campaigns to the female sexual partners of men
who have sex with men
Support programming and outreach tailored to
the particular needs of sub-groups of men who
have sex with men, such as those in the
uniformed services, prisoners, male sex workers
and those who use drugs
Support the empowerment of MSM
Scaling up What
Works – for
Combating
GBV
Evidence
Gender-based violence
correlates strongly with
women’s risk of HIV.
GBV applies to men as
well as women.
Illustrative services:
Ensure that all HIV and sexual and reproductive
health programmes address GBV and adapt
services accordingly
Initiate interventions with men/boys to change
social norms around gender roles and GBV
Implement a comprehensive approach to
reducing GBV, including
•Community awareness and education;
•Health sector interventions, including:
•Screening and referral for HIV infection of
victims of rape;
•Emergency contraception;
•Forensics examinations;
•Diagnosis and treatment of STIs;
•VCT or providing referral to VCT services; and
•PMTCT services or referral to these services,
where appropriate
Scaling up What
Works – for
Combating
GBV
Evidence
Gender-based violence
correlates strongly with
women’s risk of HIV.
GBV applies to men as
well as women.
Illustrative services:
Implement a comprehensive approach to
reducing GBV, including (continued)
•Education sector interventions such as training
education professionals to recognize the signs and
symptoms of GBV and to provide counselling and
referrals; gender-sensitivity trainings of education
professionals to reduce the chance that teachers will
become perpetrators of sexual violence; reform of
nationally mandated curricula to include gender
sensitivity and violence awareness and prevention;
and attention to the physical layout of schools so that,
for example, girls have private toilet areas;
•Policy and law reform, including education of
parliamentarians and members of the legal system,
and consistent and reliable implementation of laws;
•Income generating projects through microfinance
and other related programmes, and literacy classes
for women; and
•Establishment of women-only HIV and GBV support
groups and community centres