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HIV/AIDS and Reproductive Health

The 1994 ICPD Programme of Action articulated revised approaches to population issues. It reflected how population and development are inextricably linked, and emphasized that empowering women, and investing in education and health, including reproductive health, are necessary for both individual welfare, protection of human rights and for development.  The Programme of Action recommended a people-centered approach and called for universal access to an integrated comprehensive package of reproductive health services including HIV/AIDS through the primary health care system. The Millennium Declaration builds on the ICPD Plan of Action and reaffirms the goals of poverty reduction, universal education, gender equality, improving reproductive/maternal health, reducing child mortality, curbing the spread of HIV/AIDS and strengthened partnerships. The World Bank includes these goals in its corporate agenda.

 

But, the developing world faces an enormous task in accelerating progress to achieve the MDGs by 2015 and to address the unmet needs of reproductive health, and the challenges of curbing the spread of HIV/AIDS. Although some progress has been made, much remains to be done to build capacity to address this challenge more effectively and efficiently. In the face of an accelerating HIV/AIDS epidemic, population and reproductive and sexual health remain unfinished agendas for many developing countries.

 

Reproductive health service providers can be influential in addressing the HIV/AIDS pandemic and vice versa.  Family planning clinics that educate, diagnose, and treat sexually transmitted infections (STIs) can also be influential in educating, diagnosing and treating HIV/AIDS. During childbirth, service providers are at a considerable advantage in preventing the transmission of HIV/AIDS to the newborn.  HIV/AIDS programs can link with family planning, as often the risk that may expose an individual to HIV is the same risk that could result in an unintended pregnancy.  

 

Addressing HIV/AIDS in reproductive health services and RH in HIV/AIDS programs can provide a broader outreach to underserved groups including adolescents and men. Interventions within communities and clinic facilities can provide a broad range of preventive and clinical services at one visit, thus better meeting the needs of clients.

However, linkages between HIV/AIDS and RH and MCH country programs are generally inadequate with many missed opportunities. Existing maternal/reproductive health and family planning programs can play a vanguard role in the prevention of HIV/AIDS transmission and provide a sound basis and experience upon which interventions to curb the HIV/IDS epidemic can be built. Further, strengthening the linkages between reproductive health and HIV programs is likely to promote client satisfaction; efficiency; and effectiveness by reducing duplication of services; maximizing the utilization of scarce human and financial resources by sharing program interventions, facilities and rationalizing staff responsibilities; and thus minimizing missed opportunities.

 

To address the challenge of meeting increasing demand for reproductive and sexual health and HIV/AIDS, strong health systems are required. However, HIV/AIDS has overwhelmed and weakened health systems, decimating health workers and managers of programs. International migration of skilled workers has contributed to the brain drain in some of the worst affected countries and reduced the capacity of human resources in the system.

 

In the last thirty years, countries and donors have invested billions of dollars in vertical family planning and reproductive health programs.  Although HIV/AIDS has been around since the 1980s, political commitment by countries and donors to address the problem was slow but has recently gathered momentum. More resources are becoming available to increase access to HIV prevention, treatment and care services. Although reproductive health services are critical to prevention of HIV/AIDS, countries have not adequately exploited the existing infrastructure, logistics and information systems and skills in RH programs to address HIV/AIDS. This was a missed opportunity and costly mistake in the early 1990s. Evidently, nobody knew that HIV/AIDS would become the catastrophe it is today. The devastating impact of HIV/AIDS was clearly underestimated by donors and countries themselves.

 

Many of the currently affected countries were initially in denial about HIV/AIDS. Unfortunately, even as commitment has improved and resources for HIV/AIDS have become available, linkages between the two programs have weakened. New parallel vertical and parallel organizational structures have been established specifically to address HIV/AIDS.  Coordination between the two programs is lacking in the majority of countries. There is growing concern that with the focus on treatment, attention to prevention will diminish.

 

Concerned about these challenges, countries and donors have started to think about strengthening the linkages between reproductive health, maternal and child health services and HIV/AIDS programs.

 

RESOURCES

 

Components of reproductive health and HIV 

 

The rational for linking

Challenges to integrating reproductive health and HIV

Longrun economic costs of AIDS: Theory and an Application to South Africa

AIDS, Poverty and Debt Releif

Stigma and Discrimination (presentation by Elizabeth Lule, Pop/RH Advisor)

Strengthening the Linkages between Reproductive Health and HIV/AIDS

HIV/AIDS and Gender, World Bank website

HIV Prevention in Maternal Health Services: A Training Guide (UNFPA and EngenderHealth)