PCB Thematic Session Summary
SRH and HIV Linkages
Comprehensive Sexuality Education (CSE)
• Lack of recognition of sexual and reproductive
rights of young people
• Legal barriers prevent young people accessing
CSE and SRH/HIV services
• “Political will is fundamental and it doesn’t
cost anything”
• Misinformation about what CSE is, its impact
and importance
CSE means:
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Rights-base
Age appropriate
Gender transformative
Evidence-informed
Promotes self-esteem
and empowerment
• Biological aspects of
puberty
• Sexuality
• Contraceptives
• Options for unintended
pregnancy
• STIs/HIV
• GBV
• PLHIV
• Skills for (avoid
coercion, negotiate safe
etc.)
• Community/parents
Integration of Services
• Bi-directional service integration can work – no one
model
• Coordination mechanisms are essential
• Human resources – training and retention (multitasking, task-shifting, attitudes…) & commodities
“integration by default”
• Understanding integration in low and concentrated
epidemics
• Tailoring services for people living with HIV, key
populations, and young people
• Services for and involving men
• Reduction of stigma and discrimination
What is being integrated? (Kenya)
HIV/AIDS Services
SRH Services
VCT
FP
+ (V) CT, ART, BCC, STI, Condoms
ANC
PMTCT, ART, BCC, FP, STI, TB
+ screening, Condoms
STI, PMTCT ……
Delivery
+
Post-Partum
(V) CT, ART, BCC, FP, STI,
+ Condoms
PAC/Abortion
+ (V) CT, ART, BCC, FP, STI,
+
FP, ART, BCC,
STI, Condoms
PMTCT +
FP, ART, BCC,
STI, Condoms
ART
BCC, STI, FP
Condoms
BCC
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FP, STI, VCT
Condoms
Condoms
Post-rape
+
STI
+ (V) CT/PEP, ART, BCC, EC,
Cervical Cancer
screening
Condoms
+
(V) CT, BCC, FP, Condoms
Funding Opportunities for Integration
• ‘Shift in the balance of power’ - country
ownership for contextual solutions vs.
restrictive/conditionalities of donors
• “No such thing as a fully integrated or fully
vertical system” – bottom line is comprehensive
responsive to clients
• Importance of global voices, especially around
human rights, e.g. engagement principles
• Funding driven artificial separation of SRH & HIV
• “What we need most is integration of donors”
“Integration is not itself an end but a
means” to achieve…
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Universal access goals
Health outcomes
Human rights
Programme effectiveness/efficiency
Link between community and health
interventions
• Elimination of stigma and discrimination
GBV and HIV
• GBV is an intrinsic human rights violation and
intersects with HIV
• Inclusive definition of what constitutes GBV
(MSM/SW/TG/)
• Stigma and discrimination, social exclusion and
shame associated with GBV
• Strengthen advocacy – influence (CSOs, FBOs, etc.)
• Build capacity, to address the link between GBV and
HIV especially in humanitarian settings
• Need for more data collection and research
• Multisectoral response legal reform, policy and
programmatic (law enforcement (police, military),
health, CSE, etc.)
Support the integration of SRH and HIV
services - sustainable financing,
harmonized policies and good practice
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No one model and integration is not a panacea
Commitment by all relevant stakeholders
Coordination mechanisms and inclusion of stakeholders
Joint planning for harmonized approach
“Movement in direction of success = put in more resources”
Initially may be increased cost/allow time for change
Human resources, training and retention of health
professionals, (knowledge, attitudes & practices that uphold
human rights).
• Community and health systems strengthening
Include relevant services and systems
beyond the health sector
• CSE - UNESCO’s International Technical Guidelines on
Sexuality Education
• CSE and YFS linked - requires MoH and MoE to work
together
• “Prevention revolution must include CSE”
(e.g. LAC Ministerial Declaration “Educate to Prevent”)
• Full implementation of the Agenda for Women and
Girls
• Health , psycho-social, judicial, law enforcement
systems to address GBV and HIV
Support collaborative action research
to address key gaps
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Health outcomes
Stigma reduction
Cost-effectiveness
GBV
Men and boys
Integration in low and concentrated epidemics
SRH people living with HIV and key populations
“If we wait for evidence to catch up we will
constantly be reactive…”
Strengthen ties between maternal,
newborn & child health initiatives & HIV
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Favourable political enviornment
Comprehensive 4-pronged PMTCT
Maternal and child survival/virtual elimination
HIV integrated into ANC, PP, FP, etc.
Address stigma and discrimination
Rights of people living with HIV
Comprehensive universal SRH
Low/concentrated epidemics
Ensure linkages for key populations
(including in low/concentrated epidemics)
• Design and implement services need to do more
to meet the needs of key populations (access,
rights, etc.)
• Direct funding to community based organizations,
better at reaching and gaining trust of key
populations
• Advocacy to serve a broad constituency (universal
access)
• Engagement in policy making and programming
• Legal/policy reform (e.g. end criminalisation)
Remove punitive laws, policies, practices,
stigma & discrimination that block access
to integrated SRH and HIV services
• Legal audit and law reform, access to legal
services, programmes to reduce stigma and
discrimination, know your rights/ law campaigns
and training of key service providers
• Non-discriminatory, inclusive, participatory, and
accountable
• “Doesn’t cost a lot being brave on these issues”
• “Stand up for universality of human rights!”