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Overview of the SRH and HIV Linkage

Overview of the SRH and HIV Linkage. Dr. Jean-Baptiste ROUNGOU WHO Regional Office for Africa. Outline. Rationale for linking SRH and HIV What has been done so far? What can be done to foster linkages? Challenges Key recommendations. What do we mean by SRH and HIV linkages?.

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Overview of the SRH and HIV Linkage

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  1. Overview of the SRH and HIV Linkage Dr. Jean-Baptiste ROUNGOU WHO Regional Office for Africa

  2. Outline • Rationale for linking SRH and HIV • What has been done so far? • What can be done to foster linkages? • Challenges • Key recommendations

  3. 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.

  4. 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 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

  5. Benefits of Linkages • 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 HIVLinkages: Evidence Review & Recommendations, IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009. • 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

  6. 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

  7. Conceptual Framework Source: Sexual and Reproductive Health & HIV/AIDS: A Framework for Priority Linkages, WHO, IPPF, UNAIDS, & UNFPA, 2005.

  8. What can be done?SRH Providers should • Source: Gateways to Integration Case Studies for Haiti, Kenya and Serbia, WHO, UNFPA, UNAIDS, IPPF, 2008. • 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.

  9. 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, IPPF, 2008.

  10. 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

  11. Key Recommendations:Policy Makers • Source: Sexual & Reproductive Health and HIVLinkages: Evidence Review & Recommendations, IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009. • 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

  12. Key Recommendations:Programme Managers • Source: Sexual & Reproductive Health and HIVLinkages: Evidence Review & Recommendations, IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009. Strengthen linked SRH and HIV responses in both directions through: • 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

  13. Key Recommendations:Researchers • Source: Sexual & Reproductive Health and HIVLinkages: Evidence Review & Recommendations, IPPF, UCSF, UNAIDS, UNFPA, WHO, 2009. • 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

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