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The Global Context of Sexual and Reproductive Health & HIV: Making seamless programmes and services a reality for PLHIV Breaking down the operational and logistical barriers Lynn Collins (UNFPA) and Kevin Osborne (IPPF).

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The Global Context of Sexual and Reproductive Health & HIV: Making seamless programmes and services a reality for PLHIVBreaking down the operational and logistical barriersLynn Collins (UNFPA) and Kevin Osborne (IPPF)

integration is not itself an end but a means to achieve
“Integration is not itself an end but a means to achieve…”

Universal access goals

Health outcomes

Human rights

Programme effectiveness/efficiency

Link between community and health interventions

Elimination of stigma and discrimination

Slide from UNAIDS PCB Thematic Session on SRH HIV Linkages 21 June 2010

the u s government s global health initiative

Linkages Funding Opportunities GHI

The U.S. Government’s Global Health Initiative

“We will not be successful in our efforts to end deaths from AIDS, malaria, and tuberculosis unless we do more to improve health systems around the world, focus our efforts on child and maternal health, and ensure that best practices drive the funding for these programs.”—President Obama, May 5, 2009


Linkages Funding Opportunities GF

d. Reduce the risks and vulnerabilities that increase women’s and girls’ susceptibility to infection by the three diseases, and mitigate the impact for those already infected (Including, gender-based violence, female genital mutilation, early or forced marriage, lack of access to education, wife inheritance, increased risk due to pregnancy, discrimination in employment, etc.)

f. Include programs that empower women and girls so they can protect themselves, by having access to sexual and reproductive health care (SRH), access to female controlled prevention measures (female condom, negotiating condom-use etc.), and access to education. In this context the

Global Fund willchampion activities that strengthen

SRH-HIV/AIDS service integration.


what we need most is integration of donors
“What we need most is integration of donors!”
  • Funding has driven by artificial separation

of SRH & HIV

  • ‘Shift in the balance of power’ - country ownership for contextual solutions vs. restrictive/conditionality of donors
  • Objective is a comprehensive responsive to clients
  • Importance of global voices, especially around human rights, e.g. engagement principles

Slide based on UNAIDS PCB Thematic Session on SRH HIV Linkages 21 June 2010


Linkages benefits for People Living with HIV

  • Allows continuity of care without being externally referred
  • Expands range of clinical services beyond ARVs
  • Reduces frequency/costs of appointments
  • Reduces HIV related stigma and discrimination
  • Provides increased coverage for key populations
  • Promotes an increased
  • culture of rights


rapid assessment tool for srh and hiv linkages
Rapid Assessment Tool for SRH and HIV Linkages
  • Assesses HIV and SRH bi-directional linkages - policy, systems, and service-delivery
  • Identifies current critical gaps
  • Contributes to the development of country-specific action plans to strengthen linkages.
  • Focuses primarily on health sector

Stand-alone activity or part of larger review

Includes desk reviews & individual/group interviews

Ensure at a minimum the assessment team includes:

national government SRH and HIV units

networks of people living with HIV

key populations

civil society

UN organizations


Estimated timeframe: 3 months

Appendix 3. Budget for Estimating Cost: USD 30 – 50K

Appendix 5. Next Steps for Utilization of Findings

Implementation - Rapid Assessment Tool

rapid assessment tool

Roll-out conducted in 16 countries in 5 regions

Africa•         Benin •         Botswana •         Burkina Faso•         Cote D\'Ivoire •         Malawi •         Swaziland •         Tanzania •         Uganda

Latin America and Caribbean•         Belize

Eastern Europe and Central Asia•         Kyrgyzstan •         Russian Federation

Arab States•         Lebanon •         Morocco •         Tunisia

Asia and Pacific•         Pakistan •         Viet Nam

Rapid Assessment Tool

Available languages:

Arabic, English, French, Russian and Spanish


Linkages Barriers - Policy

  • Insufficient attention to the full scope of linkages issues (legislative, socio-economic, cultural)
  • Weak links btn natl’ AIDS & SRH strategies& plans
  • Vertical programming

based on separate funding streams

  • Poor linkages btn health and other sectors education, gender, economic
  • No linkages strategy & implementation plan
  • Absence linkages

in national




Linkages Barriers – Policy cont.

  • Conditionality in funding
  • Laws and policies on rights requiring reform (e.g. age of consent for services; human rights, gender equality, age at marriage, gender-based violence, discrimination, treatment access, criminalisation, etc.)
  • Lack of awareness of rights to health and non-discrimination
  • Multiple obstacles to SRH and HIV service access for PLHIV and key populations
  • Low level of male engagement in SRH and HIV
  • Avoidance of sensitive issues


Linkages Barriers - Systems

  • Weak coordination mechanisms
  • Underutilized joint capacity building
  • Absence of shared monitoring and evaluation systems
  • Weak health systems
  • Inadequate links with community
  • Insufficient integration of PMTCT into SRH, including family planning
  • Weak capacity and inadequate engagement of PLHIV, key populations, etc.
  • Lack of

commodities & equipment


Linkages Barriers - Services

  • Inadequate human resources/support
  • Stigma and discrimination toward people living with HIV and key populations, by and toward health providers
  • Overburdening of health providers
  • Attrition of health providers
  • Lack of capacity to cope with increased numbers of clients
  • Weak capacity building for multi-tasking and task-shifting (need for new knowledge, skills, and non-judgemental attitudes)

moving the rights agenda along
Moving the rights agenda along

Recognize service integration is not a panacea

Go beyond the health sector

Support research to address key gaps (e.g. linkages in low/concentrated epidemics, etc.)

Keep stigma and discrimination high on the agenda

Support legal & policy reform, remove punitive laws

Direct funding & better engage community/civil society to achieve universal access