Transcript Slide 1

Making the Most of It:
Sexual and Reproductive Health (SRH) and HIV Linkages
Inter Agency Working Group on SRH and HIV Linkages
Established in 2008. Co-convened by UNFPA, WHO and IPPF.
Other partners include: UNAIDS, EngenderHealth, Family Health International (FHI),
Guttmacher Institute (GI), Population Council, The Global AIDS Alliance (GAA), The Global
Fund to fight AIDS, Tuberculosis, and Malaria (GFATM), The Global Network of People
Living with HIV (GNP+), The World Bank (WB), UNDP and USAID.
Why should we link SRH
and HIV?
Rationale for Linking SRH & HIV
 Majority of HIV infections
 sexually transmitted, or
 associated with pregnancy, childbirth & breastfeeding
 Common root causes
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Poverty
Gender inequality
Gender-based violence
Human rights violations
Marginalisation of key populations
Stigma and discrimination
Source: Sexual and Reproductive Health & HIV/AIDS: A Framework for Priority Linkages, WHO, IPPF,
UNAIDS, & UNFPA, 2005
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.
What Do We Mean by “Linkages” &
“Integration”*?
 Linkages - The bi-directional synergies in policy, programmes,
services 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.
 Integration - Different kinds of sexual and reproductive health
and HIV services or operational programmes that can be
joined together to ensure and perhaps maximize collective
outcomes. This would include referrals from one service to
another, for example. It is based on the need to offer
comprehensive services.
* Definitions
agreed upon by the IAWG on Linkages
Principles for Linking
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Address structural determinants
Focus on human rights and gender
Promote a coordinated and coherent response
Meaningfully involve PLHIV
Foster community participation
Reduce stigma and discrimination
Recognise the centrality of sexuality
Source: Rapid Assessment Tool for Sexual & Reproductive Health and HIV Linkages: A generic guide, IPPF,
UNFPA, WHO, UNAIDS, GNP+, ICW, Young Positives, 2009.
SRH and HIV Linkages Agenda
Political Commitment
Priority Framework
Evidence Review
Rapid Assessment Tool
Indicators
Conceptual Framework
Source: Sexual and Reproductive Health & HIV/AIDS: A Framework for Priority Linkages, WHO, IPPF,
UNAIDS, & UNFPA, 2005.
Linkages:
More Than Integration
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Child marriage
Gender-based violence
Gender inequality
Human rights violations
Poor access to quality services
Coerced sex
Criminalization of HIV
Stigma and discrimination
Lack of empowerment/participation
Linkages:
What Can Be Done
Examples
Joint Advocacy to End:
 Child marriage
 obstetric fistula, increased morbidity/
mortality, increased HIV risk…
 Gender-based violence
 Human rights violations, lack of access to education, increased HIV
risk, violence against women living with HIV…
 Criminalization of HIV
 Human rights violations, adverse impact
on women, forced disclosure of status…
Source: Ending Child Marriage: A Guide for Global Policy Action, IPPF, Young Positives, UNFPA, GCWA, 2006.
Verdict on a Virus: Public Health, Human Rights and Criminal Law, IPPF, GNP+, ICW, 2008.
Service Integration:
What SRH Providers Can Do
 HIV prevention information and services, including for people living with
HIV;
 Information to prevent unintended pregnancies and HIV/STIs (dual
protection) through correct and consistent condom use; provision of male
and female condoms
 Nondirective, nonjudgmental and confidential counselling on SRH of people
living with HIV;
 HIV counselling and testing and ART as indicated;
 Strengthen maternal and child health services by including elements of
prevention of mother-to-child transmission services; and
 Address the SRH needs of key populations, including men who have sex
with men, people who use drugs, sex workers and their clients.
Source: Gateways to Integration Case Studies for Haiti, Kenya and Serbia, WHO, UNFPA, UNAIDS, IPPF, 2008.
Service Integration:
What HIV Providers Can Do
 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, IPPF, 2008.
Service Integration:
PMTCT What Can Be Done
 Deliver comprehensive package
of PMTCT services
 Integrate HIV counselling &
testing into SRH
 Provide high quality SRH to
women living with HIV
 Integrate SRH into ART centres or
strengthen referrals
 Provide family planning
counselling and services during
antenatal and post-partum care
 Screen and treat for syphilis and
other STIs
 Develop appropriate guidelines,
tools & competencies for SRH
people living with HIV in the
context of PMTCT
Source: Guidance on Global Scale-Up of the Prevention of Mother-to-Child Transmission of HIV, IATT on
Prevention of HIV Infection in Pregnant women, Mothers and their Children, 2007.
SRH & Human Rights of People Living with HIV
Source: Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV: A
Guidance Package, GNP+, ICW, Young Positives, Engender Health, IPPF, UNAIDS, 2009.
Community Engagement
Source: HIV Prevention Report Cards for Young Women and Girls, IPPF, UNFPA, GCWA, Young
Positives, 2006-2009.
The Evidence
 A systematic review showed that
linking SRH and HIV services is
beneficial and feasible:
– Increases access to and uptake of
services
– Improves health and behavioural
outcomes, including condom use
– Increases knowledge of HIV and other
STIs
– Improves quality of services
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations, IPPF, UCSF,
UNAIDS, UNFPA, WHO, 2009.
SRH-HIV Linkages Matrix
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations, IPPF, UCSF,
UNAIDS, UNFPA, WHO, 2009.
Key Recommendations:
Policy Makers
 Develop, adopt, modify 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 human rights and
gender-sensitive approach to SRH and HIV linkages,
including through the meaningful involvement of civil
society and groups representing people living with HIV.
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations, IPPF, UCSF,
UNAIDS, UNFPA, WHO, 2009.
Key Recommendations:
Programme Managers
Strengthen linked SRH and HIV responses in both
directions through:
 Stakeholder commitment
 Human resources and planning
 Health provider training
 Client education involvement
 Quality of services
 Infrastructure
 Supply management including commodity security
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations, IPPF, UCSF,
UNAIDS, UNFPA, WHO, 2009.
Key Recommendations:
Researchers
 Design rigorous studies to evaluate integrated SRH and HIV
services, particularly comparative assessments of integrated
delivery of services versus non-integrated delivery of the
same services.
 Evaluate key outcomes, such as:
 Health, Stigma reduction, Cost-effectiveness
 Trends in access to services
 Direct research toward areas that are under-studied
(linked services targeting men and boys, comprehensive SRH
services for people living with HIV, gender-based violence
prevention)
Source: Sexual & Reproductive Health and HIV Linkages: Evidence Review & Recommendations, IPPF, UCSF,
UNAIDS, UNFPA, WHO, 2009.
Rapid Assessment Tool for SRH and
HIV Linkages: A Generic Guide
 Assess HIV and SRH bi-directional
linkages at the policy, systems, and
service-delivery levels.
 Identify current critical gaps in
policies and programmes.
 Contribute to the development of
country-specific action plans to
forge and strengthen these linkages.
 Focus primarily on the health sector.
Source: Rapid Assessment Tool for Sexual & Reproductive Health and HIV Linkages: A generic guide, IPPF,
UNFPA, WHO, UNAIDS, GNP+, ICW, Young Positives, 2009.
Implementing the Rapid Assessment Tool
 Stand-alone activity or part of a larger review of national response
 Includes desk reviews & individual/group interviews
 Ensure at a minimum the assessment team includes:
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national government SRH and HIV units
networks of people living with HIV
key populations
civil society
UN organizations
donors
 Estimated timeframe: 3 months
 Appendix 3. Budget Outline for Estimating Cost: USD 30,000 – 50,000
 Appendix 5. List of Selected Possible Next Steps for Utilization of the
Assessment Findings
Source: Rapid Assessment Tool for Sexual & Reproductive Health and HIV Linkages: A generic guide, IPPF,
UNFPA, WHO, UNAIDS, GNP+, ICW, Young Positives, 2009.
The Way Forward
 Measuring linkages progress
 Strengthening joint advocacy
between SRH and HIV e.g.
maternal health initiatives /
PMTCT
 Evolving dynamic field
Source: Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on Construction of Core Indicators, UNAIDS, 2009.
National-Level Monitoring of the Achievement of Universal Access to Reproductive Health, WHO, UNFPA, 2007.