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)
www.aids2010.org
“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
www.aids2010.org
Funding for Wider Health Initiatives
www.aids2010.org
3
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
www.aids2010.org
www.globalhealth.gov/initiatives/05192010b.ppt
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 will champion activities that strengthen
SRH-HIV/AIDS service integration.
http://www.theglobalfund.org/documents/strategy/TheGenderEqualityStrategy_en.pdf
www.aids2010.org
5
“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
www.aids2010.org
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
www.aids2010.org
7
Rapid Assessment Tool
for SRH and HIV Linkages
 Assesses HIV and SRH bidirectional 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
www.aids2010.org
Implementation - Rapid
Assessment Tool
 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
 donors
 Estimated timeframe: 3 months
 Appendix 3. Budget for Estimating Cost: USD 30 – 50K
 Appendix 5. Next Steps for Utilization of Findings
www.aids2010.org
Rapid Assessment Tool
Roll-out conducted in 16 countries in 5 regions
Africa
•
Benin
•
Botswana
•
Burkina Faso
•
Cote D'Ivoire
•
Malawi
•
Swaziland
•
Tanzania
•
Uganda
Eastern Europe and Central
Asia
•
Kyrgyzstan
•
Russian Federation
Latin America and
Caribbean
•
Belize
Asia and Pacific
•
Pakistan
•
Viet Nam
www.aids2010.org
Arab States
•
Lebanon
•
Morocco
•
Tunisia
Available languages:
Arabic, English, French, Russian and Spanish
Linkages Barriers - Policy
• Insufficient attention
to the full scope of
linkages issues
(legislative, socioeconomic, cultural)
• Weak links btn natl’
AIDS & SRH
strategies& plans
• Vertical
programming
based on separate
funding streams
www.aids2010.org
• Poor linkages btn
health and other
sectors education,
gender, economic
• No linkages
strategy &
implementation
plan
• Absence linkages
in national
dev./health
strategies
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, genderbased violence,
discrimination,
treatment access,
criminalisation, etc.)
www.aids2010.org
• 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
www.aids2010.org
• 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
www.aids2010.org
• Lack of capacity to
cope with increased
numbers of clients
• Weak capacity
building for multitasking and taskshifting (need for new
knowledge, skills, and
non-judgemental
attitudes)
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
www.aids2010.org
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