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On the integration of programs…. Luis Gutierrez Alberoni. PROPOSAL TO INTEGRATE SEXUAL AND REPRODUCTIVE HEALTH PROMOTION PROGRAMS AND SERVICES WITH THE HIV (AND STI) RESPONSE. Rafael Maz í n, MD; MPH Luis Gutierrez Alberoni Quito, Ecuador. 29 October 2007. BASIC PREMISES

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Onthe integration of programs…

Luis Gutierrez Alberoni

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PROPOSAL TO INTEGRATE SEXUAL AND REPRODUCTIVE HEALTH PROMOTION PROGRAMS AND SERVICES WITH THE HIV (AND STI) RESPONSE

Rafael Mazín, MD; MPH

Luis Gutierrez Alberoni

Quito, Ecuador. 29 October 2007

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BASIC PREMISES

  • Epidemiological evidence:
  • Dynamic of HIV epidemic closely associated with all unprotected sex (> 80% of the cases)
  • Infant mortality rate related to parental sexual behavior
  • STIs neglected in health agendas (50 million cases annually), 110,000 cases of congenital syphilis
  • Unsatisfactory efforts in prevention ( ∆12% in new cases in Latin America between 2004 and 2006)
  • Access to treatments at risk (6 new infections for each person in treatment)
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BASIC PREMISES

  • Epidemiological evidence:
  • < 10% of acts of coitus at risk for HIV are protected by condoms
  • More than 85% of HIV+ individuals do not know their status
  • < 20% people with STIs seek professional care
  • < 20% of HIV+ pregnant women have access to prophylactic treatment
  • < 10% MSM have access to prevention and < 20% female SWs have access to prevention
  • Stigma, discrimination, homophobia, abuse are all still common in health services
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BASIC PREMISES

  • Contextual analysis:
  • General difficulty in dealing with sexuality
  • Neglect of masculinity, sexual orientation, attraction, pleasure, and power
  • Sexual health reduced to reproductive dimension
  • Sexual health linked with reproductive health, but not always with mental health, other areas
  • Responses almost exclusively through health
  • “Medicalization” (i.e., prevalance of a curative paradigm)
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BASIC PREMISES

  • Analysis of the responses:
  • HIV programs have “tubular” structure
  • Interventions focused on sporadic events
  • Services and activities focused on populations of childbearing age
  • Lack of access to SRH promotion and care for especially vulnerable populations
  • Lack of interest in non-routine interventions
basic premises

BASICPREMISES

Sexuality, Health, and Well-being

Reproduction

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SRH

Integration: High potential for benefits

Key Links

  • HIV/AIDS
    • Prevention
    • Treatment
    • Care
    • Support

1. Know HIV status

2. Promote safer sex

3. Optimize the connectionbetweenHIV/AIDS services and STI services

4. Integrate HIV/AIDS with maternal and child health

  • Family planning
  • Maternal and child care
  • STI management
  • Management of other SRH problems

Source: SSR y VIH/SIDA. Un marco de referencia para establecer vínculos prioritarios. (WHO, UNFPA, UNAIDS, IPPF, 2005)

four strategic areas in the action plan

FOUR STRATEGIC AREAS INTHE ACTION PLAN

Attitudes, values, and social behavior: Greater notification and understanding of the causes and impact ofHIV/AIDS, with greater commitment to prevent and reduce impact

Individual knowledge, skills, and behavior: People in vulnerable groups have knowledge,skills, self-esteem, and motivation to protect themselves

Programs and services: Effective and accessible programs and services with integrated SRH activities and prevention and reduction of HIV/AIDS impact

Information: Information and evidence base for sustaining policies, program development, monitoring, and decision-making

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GOALS:- a)Improve information, services, and support- b) Reduce inequities in sexual health - c) Improve health, sexual health, and well-being

PRINCIPLES:

Appropriate services for individuals, their families, and their health care providers

Integrated actions

Focus on maintaining health and reducing inequities

Services “without interruptions”

Adaptation to specific needs

Ongoing improvement of services

Respect for confidentiality and availability of information on services and treatments

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THREE PILLARS OF THE STRATEGY I. BETTER PREVENTIONPublic informationGuide on the use of evidence Clear goals in prevention (new HIV infections, unprotected sex, measured by STI rates including rectal gonorrhea) General goals at the national level II. BETTER SERVICESChlamydia detection in certain groups Reinforce role of PHC Improve skills of PHC providersIncrease HBV vaccination coverage III. BETTER MANAGEMENT

Local commissions with various agencies and sectors represented

Local goals linked to national goals

Planning based on study of local needs

Forging of professional partnerships and participation

Participation of families and communities

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From Montevideo I and II to Montevideo III:

Scope of the Integration Strategy

  • GOAL:Sexual well-being of people, families, andcommunities
  • Integration of SRH and responses to HIV/STIs into national and local programs
  • SRH policies on risk and damage control associated with sexual behavior and reproduction or with values, attitudes and beliefs related to these
  • Integrated health services for young people and adults
  • Development of professional skills in SRH
  • Linkage of health care actions with those in homes, schools, communities
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From Montevideo I and II to Montevideo III: Areas for Integration

  • Emphasis on Prevention
  • Emphasis on Risk and Vulnerability
  • Redimension STIs
  • Opportunities for concrete achievements
  • Gender, masculinity, and power
  • Integrating role of the health sector
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From Montevideo I and II to Montevideo III:Proposals for Action

  • Political commitment
  • Integration among sectors
  • Promotion of gender agenda
  • SRH care for men and women
  • STI Programs
  • Community Participation
  • Comprehensive sex education
  • Training in sexuality and sexual health
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From Montevideo I and II to Montevideo III: Suggested Key Strategies

  • Comprehensive information for decision-making
  • Health services that are accessible, inclusive, integrated, and effective
  • Promotion of sexual and reproductive health and well-being for the population
  • Integrated, efficient management and administration to carry out the integration strategy
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Montevideo III: Next Steps

  • Review the Strategic Proposal
  • Review and articulate with other potential members
  • Construction of matrix of actions and interventions
  • Presentation of Family and Community Health strategy as an example
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