UNFPAState of World Population 2004
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Preventing HIV/AIDS

Impact and Response
Linking HIV Prevention and Reproductive Health Programmes
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Key Challenges

Linking HIV Prevention and Reproductive Health Programmes

Since a majority of HIV transmission takes place through sexual contact, reproductive and sexual health information and services provide a critically important entry point to HIV/AIDS prevention. They also provide a conduit to and delivery point for programmes of care and treatment.

Reproductive health services can help prevent HIV transmission by: providing education on risks to influence sexual behaviour; detecting and managing sexually transmitted infections (STIs); promoting the correct and consistent use of condoms; and helping to prevent mother-to-child transmission.(10) Linking HIV prevention and the prevention and treatment of STIs with family planning and maternal health interventions can improve outreach, reduce stigma and save money by using existing resources and infrastructure.

A number of initiatives, primarily in Africa, have sought to link HIV prevention and reproductive health programmes.(11) But in many settings, the two programmes are not linked to each other.

CALL TO COMMITMENT. In June 2004, UNFPA, UNAIDS and Family Care International convened a high-level global consultation, involving health ministers, parliamentarians, ambassadors, leaders of UN agencies, donor organizations, community and NGO leaders, young people and people living with HIV. The meeting resulted in a Call to Commitment that emphasized “the urgent need for much stronger links between sexual and reproductive health and HIV/AIDS policies, programmes and services”.

Closer links—including provision of reproductive health information and services to all people reached by HIV/AIDS programmes, and of HIV/AIDS information and services to all people reached by reproductive health programmes—are critical to success in both areas and to achieving the MDGs, the call stated, and “will result in more relevant and cost-effective programmes with greater impact”.

EDUCATION ON RISKS. Up to now, few family planning programmes have focused on enabling providers to deal with sexuality issues. A recent study in the United Republic of Tanzania, for example, found that HIV/AIDS was mentioned to family planning clients only briefly during counselling for informed choice, when “women were told that condoms prevent STIs such as HIV, and other methods do not”.(12)

The International Planned Parenthood Federation has trained a number of family planning associations on sexuality, gender and quality of care.(13) These experiences have shown that counselling on sexuality can take place if providers have adequate training. In studies in Kenya and Zambia, however, most providers said they doubted their ability to adequately counsel clients on contraceptive needs in light of HIV.(14)

Programmes need to train all providers to help clients assess HIV risk and counsel them about avoiding both disease and unintended pregnancy. Training must also include correct information on contraceptive methods to help dispel the myths and rumours that abound.

MANAGING STIs. The presence of one or more STIs significantly increases the risk of becoming infected with HIV. A recent U.S. study found that treating an STI in an HIV-infected person can result in a 27 per cent reduction in HIV transmission, without any other behaviour change.(15) A study in the United Republic of Tanzania in the mid-1990s showed that preventing and treating STIs could prevent about 40 per cent of new HIV infections.(16) The study also showed that community-based publicity, partner notification and treatment efforts could reduce the spread of STIs.

Reproductive health programmes can educate service users about STIs, their symptoms and transmission, and healthy behaviour. Detecting and managing STIs has proven difficult, however. Most women with STIs have no symptoms, and as a result, efforts to identify and treat them in reproductive health settings have proven to be of little benefit for women.(17) Consequently, STIs have not received adequate attention in either reproductive health or HIV programmes,(18) and health ministries have done little to ensure that they are included.(19) The recent development of cheaper tests for common STIs could help remedy this deficiency.

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