Promoting integration of HIV prevention and SRH to better serve women and girls
On Thursday, students from the Limkokwing University of Creative Technology (LUCT), Communications and PR department held a very interesting debate and panel discussion around issues of Sexual and reproductive health (SRH). I found the subject quite interesting and realised how important it is to integrate HIV prevention and SRH in order to better serve our adolescent girls and young women.
Sexual and reproductive health refers to programs and policies related to and including family planning (FP), maternal and new born health, STIs, reproductive tract infections, promotion of sexual health, prevention and management of gender-based violence, prevention of unsafe abortion and post-abortion care, upon doctor’s recommendation.
Last year the Eswatini HIV Recent Incidence Surveillance (EHRIS), gave alarming results about 10 Tinkhundla which had the highest increase in new HIV infections. This became a cause for concern for the multisectoral HIV response as new infections were higher among adolescent girls and young women. Without a doubt, this means this population is engaging in unprotected sex thereby posing a huge risk to HIV acquisition.
This said, the international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to both sexual and reproductive health services and HIV/AIDS prevention, treatment, care and support. Recently, there has been increasing awareness and discussion of the possible benefits of linkages between SRH and HIV programmes at the policy, systems and service delivery levels. However, the evidence for the efficacy of these linkages has not been systematically assessed.
Why link HIV/AIDS and sexual and reproductive health
The importance of linking HIV/AIDS as a part of SRH is abundantly clear: the majority of HIV cases, about 85%, are sexually transmitted and both HIV/AIDS and many illnesses linked to SRH have the same root causes. The greater proportion of paediatric HIV infections is spread from mother-to-child in the process of pregnancy, childbirth, and breastfeeding. As articulated before, in Eswatini, the majority of new HIV cases are among women and girls, a major target of SRH services. Despite these overlaps, HIV/AIDS and SRH services have been historically separate and uncoordinated.
Linkages between SRH and HIV-related policies and programmes may lead to a number of important public health, societal and health systems benefits. Linkages are expected to improve coverage, access to and uptake of both SRH and HIV services for vulnerable and key populations (where HIV risk and vulnerability converge), including people living with HIV (PLHIV). Linking SRH and HIV interventions may lead to a reduction in HIV-related stigma and discrimination by integrating HIV with other SRH services. Linkages may enhance programme effectiveness and efficiency as redundancies in vertical programmes are eliminated and clients' multiple needs are addressed in one setting .
These potential efficiencies and cost savings are particularly important in the context of a maturing global response to HIV that focuses less on emergency measures and more on ensuring long-term sustainability and integration of HIV programmes with other programmes and health systems. Linkages may improve access to family planning and other key SRH services for PLHIV, thereby reducing perinatal transmission with a cost-effective component of prevention of mother to child transmission (PMTCT) and ensuring access by PLHIV to SRH services tailored to their needs.
It is pleasing to note that as a country we have done tremendously well in SRH and HIV linkages in other areas such as the prevention of mother to child transmission (PMTCT). To date, transmission of HIV from mother to child at 6 – 8 weeks has been reduced to 2% as over 80% of pregnant women access (PMTCT) services. Expectant mothers are initiated on ART immediately after testing positive for HIV, without consideration of CD4 count. PMTCT services have been scaled up country-wide with good results for pregnant lactating women and exposed children.
Putting women and girls at the centre of the response
Integrating HIV and sexual & reproductive health (SRH) is the future of prevention. To end the HIV epidemic, it is fundamental to put women at the center of the response. This means making it easier for women and girls to access quality, comprehensive HIV/SRH care where and when they feel comfortable, bringing down barriers, and developing multipurpose prevention technologies that address many SRH needs with a single product. There is still much to be done to fully realize the vital work of integrating HIV treatment and prevention with sexual and reproductive health (SRH).
Benefits of Linking HIV and SRH
Integrated services are now seen as a key strategy for overcoming missed opportunities of meeting the needs of overlapping target populations in HIV prevention and SRH services. Moreover, there is widespread recognition that strengthening linkages between HIV and SRH programs could lead to a number of important public health, socio-economic, and individual benefits, such as:
- Improving access to and use 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” (correct and consistent condom use to prevent HIV and unintended pregnancy)
- Improved quality of care
- Decreased duplication of efforts and competition for resources
- Better understanding and protection of individuals’ rights
- Mutually reinforcing complementarities in legal and policy frameworks
- Enhanced program effectiveness and efficiency
- Better utilization of scarce human resources for health
There remains a great need to strengthen HIV prevention interventions as adolescents and young women continue to be vulnerable to HIV. Statistics show that the highest number of new infections are still being experienced among 15–24-year-old adolescents and young women. This is perpetuated by inequalities in power, status, rights and voice. This further presents the need for strategies to empower girls and young women to increase their voice, bodily autonomy and agency, thus decreasing their vulnerability to HIV infection. We must do more to protect young girls from the clutches of rich and powerful men who engage in inter-generational sex, transactional sex and many times have multiple sexual partners.