1. Mobilizing for RH/HIV Integration Addis Ababa, Ethiopia Session on Technical Issues and Intersections Wednesday, February 26, 2008

2. Relevant Components of GF Proposals Prevention Treatment Care and Support Health systems strengthening Gender Vulnerable populations M&E indicators

3. Entry Points for SRH in GF Service Areas and M&E GP/012207/2 Supportive Environment Prevention Care & Support Treatment HIV/AIDS ARV OI Policy development Strengthening CS and HS Stigma reduction Increasing ‘Coverage’ Key indicators Increased people trained to deliver services Increased service points supported Increased people reached For chronically ill OVC BCC Condom VCT PMTCT

4. CCM Guidelines for Prioritized Integration Services/programs STI VCT PMTCT ART Adolescent programs Vulnerable populations Gender-based violence Procurement Policy and operational barriers

5. Matrix: GF Proposal Components and SRH Entry points Components for GF SRH links Preven- tionTreatment Care and support HSSGenderM&E STI XX VCT XX PMTCT XXX Adolescent XXXXX Vulnerable Populations XXXXX GBV XXXXXX Procurement XX Policy and operational barriers XX

6. Overarching Activities for all Entry Points Capacity building to ensure all relevant providers can offer integrated services Advocacy for commitments and resource allocations, and procurement for supplies Adding indicators to track integrated services in M&E systems Address gender issues Address policy and operational barriers  STI  VCT  PMTCT  ART  Adolescent programs  Vulnerable populations  Gender-based violence

7. Thank you Other Entry Points for Integration Follow from the Other Presenters

8. Scaling up What Works – in VCT Illustrative services:  Promote VCT in all relevant service sites  Counsel HIV- on safer sex  Offer VCT to all pregnant women  Encourage couples with infant loss for VCT  Information on dual protection/method use  Promote couples VCT, discussion of STI, pregnancy prevention  ART in SRH settings or referrals to ART  Promote VCT for adolescents and vulnerable groups and ensure appropriate services  Ensure VCT for rape victims and provide PEP  Promote programs to destigmatize HIV Illustrative services:  Promote VCT in all relevant service sites  Counsel HIV- on safer sex  Offer VCT to all pregnant women  Encourage couples with infant loss for VCT  Information on dual protection/method use  Promote couples VCT, discussion of STI, pregnancy prevention  ART in SRH settings or referrals to ART  Promote VCT for adolescents and vulnerable groups and ensure appropriate services  Ensure VCT for rape victims and provide PEP  Promote programs to destigmatize HIV Evidence Knowledge of status is an entry to other services; most don’t know their status

9. Scaling up What Works – in STI Illustrative Services:  Point-of-care diagnosis/treatment of STI  VCT or referral  Education on dual protection/dual method use  Provide male/female condoms  Safer sex campaigns  Increase access to prevention information Increase access to young people and vulnerable populations  Ensure access to all related services Illustrative Services:  Point-of-care diagnosis/treatment of STI  VCT or referral  Education on dual protection/dual method use  Provide male/female condoms  Safer sex campaigns  Increase access to prevention information Increase access to young people and vulnerable populations  Ensure access to all related services Evidence STI (b. vaginosis) can double women’s susceptibility to HIV

10. Scaling up What Works – in PMTCT Illustrative services:  Provide information about HIV transmission modes and protection  Ensure access for all clients to the management of STIs, TB, Hepatitis and malaria  Promote protection against both HIV transmission and unintended pregnancy  Ensure access for men and women to FP information and services in PMTCT+ and VCT  Improve antenatal VCT programmes  Promote couples VCT  Ensure that male and female condoms are available in all sites  Include / link PMTCT+ with all relevant services  Provide antenatal syphilis screening and treatment in PMTCT+  Support community engagement on PMTCT+  Provide women living with HIV with ongoing counselling and services, including the range of options on pregnancy Illustrative services:  Provide information about HIV transmission modes and protection  Ensure access for all clients to the management of STIs, TB, Hepatitis and malaria  Promote protection against both HIV transmission and unintended pregnancy  Ensure access for men and women to FP information and services in PMTCT+ and VCT  Improve antenatal VCT programmes  Promote couples VCT  Ensure that male and female condoms are available in all sites  Include / link PMTCT+ with all relevant services  Provide antenatal syphilis screening and treatment in PMTCT+  Support community engagement on PMTCT+  Provide women living with HIV with ongoing counselling and services, including the range of options on pregnancy Evidence Preventing HIV in women and preventing unintended pregnancy are key elements in PMTCT.

11. Scaling up What Works – in ART Illustrative services:  Provide effective referrals for ART in VCT in SRH settings  Provide ART and monitoring within SRH settings, if feasible  Integrate guidance on ART side effects and adherence with SRH services  Integrate SRH-related information and services, including provision of contraceptives, within ART programmes Illustrative services:  Provide effective referrals for ART in VCT in SRH settings  Provide ART and monitoring within SRH settings, if feasible  Integrate guidance on ART side effects and adherence with SRH services  Integrate SRH-related information and services, including provision of contraceptives, within ART programmes Evidence People on ART are sexually active and want access to contraception and other services where they receive ART.

12. Scaling up What Works – for Adolescents Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for adolescents, including OVC  Promote partnerships with and referrals to other service providers.  Develop age appropriate health communication and BCC programmes with information on preventing  HIV and unintended pregnancy and positive prevention  Promote adolescent VCT  Provide access for all adolescents to STI, HIV and contraceptive information and services  Address gender dimensions with adolescents, including GBV, same sex sex Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for adolescents, including OVC  Promote partnerships with and referrals to other service providers.  Develop age appropriate health communication and BCC programmes with information on preventing  HIV and unintended pregnancy and positive prevention  Promote adolescent VCT  Provide access for all adolescents to STI, HIV and contraceptive information and services  Address gender dimensions with adolescents, including GBV, same sex sex Evidence In countries with high HIV prevalence, young people, especially girls, are at particular risk of HIV.

13. Scaling up What Works – for Adolescents, continued Illustrative services:  Develop school and community-based life skills-building programmes for young people  Support whole-of-community site interventions  Support gender-based violence outreach and training for boys that addresses gender norms and life skills  Provide post-rape care  Support in- and out- of school peer education programmes  Provide or refer to tuberculosis, hepatitis C and drug treatment services  Ensure equitable access for HIV-positive adolescents to ART  Increase skilled attendance at birth for adolescents to reduce obstetric fistula Illustrative services:  Develop school and community-based life skills-building programmes for young people  Support whole-of-community site interventions  Support gender-based violence outreach and training for boys that addresses gender norms and life skills  Provide post-rape care  Support in- and out- of school peer education programmes  Provide or refer to tuberculosis, hepatitis C and drug treatment services  Ensure equitable access for HIV-positive adolescents to ART  Increase skilled attendance at birth for adolescents to reduce obstetric fistula Evidence In countries with high HIV prevalence, young people, especially girls, are at particular risk of HIV.

14. Scaling up What Works – for Vulnerable Populations (IDU) Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for IDU  Promote partnerships with and referrals to other service providers.  Support safer-sex campaigns and information about HIV transmission modes for IDU  Undertake community-based research with drug users  Ensure that VCT programmes provide VCT services to IDU  Integrate SRH and VCT into other programs for IDU  Support behaviour-change interventions, including information on positive prevention and protecting against HIV and unintended pregnancy  Support peer education and outreach programs with drug users Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for IDU  Promote partnerships with and referrals to other service providers.  Support safer-sex campaigns and information about HIV transmission modes for IDU  Undertake community-based research with drug users  Ensure that VCT programmes provide VCT services to IDU  Integrate SRH and VCT into other programs for IDU  Support behaviour-change interventions, including information on positive prevention and protecting against HIV and unintended pregnancy  Support peer education and outreach programs with drug users Evidence Injecting drug-related epidemics do not remain limited to IDU.

15. Scaling up What Works – for Vulnerable Populations (IDU) Illustrative services:  Provide clean needle and syringe distribution or exchange, or referral to these services  Provide referral to opioid substitution therapy programmes  Provide primary health care, such as hepatitis B vaccination and vein care  Provide or refer drug users living with HIV to ART, OI, and care and support programmes  Ensure equitable access for HIV-positive injecting drug users to ART  Ensure that pregnant HIV-positive injecting drug users have access to PMTCT+ programmes  Provide (or refer to) services for the diagnosis and treatment of STIs, tuberculosis, malaria and hepatitis C, when indicated, and treatment for drug dependency  Institute demand-reduction activities  Support the empowerment of drug users Illustrative services:  Provide clean needle and syringe distribution or exchange, or referral to these services  Provide referral to opioid substitution therapy programmes  Provide primary health care, such as hepatitis B vaccination and vein care  Provide or refer drug users living with HIV to ART, OI, and care and support programmes  Ensure equitable access for HIV-positive injecting drug users to ART  Ensure that pregnant HIV-positive injecting drug users have access to PMTCT+ programmes  Provide (or refer to) services for the diagnosis and treatment of STIs, tuberculosis, malaria and hepatitis C, when indicated, and treatment for drug dependency  Institute demand-reduction activities  Support the empowerment of drug users Evidence Injecting drug-related epidemics do not remain limited to IDU.

16. Scaling up What Works – for Vulnerable Populations (Sex Workers) Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for sex workers  Promote partnerships with and referrals to other service providers.  Support safer sexual behaviours for sex workers, partners and clients  Support safer-sex campaigns and information about HIV transmission modes for sex workers  Undertake community-based research with sex workers  Provide sex workers with information and contraceptive services, including efficacy rates for pregnancy prevention and use with HIV drugs  Provide primary point-of-care comprehensive diagnosis and treatment of STIs, including screening and treatment for syphilis, access to commodities, such as male and female condoms and lubricants, and VCT Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for sex workers  Promote partnerships with and referrals to other service providers.  Support safer sexual behaviours for sex workers, partners and clients  Support safer-sex campaigns and information about HIV transmission modes for sex workers  Undertake community-based research with sex workers  Provide sex workers with information and contraceptive services, including efficacy rates for pregnancy prevention and use with HIV drugs  Provide primary point-of-care comprehensive diagnosis and treatment of STIs, including screening and treatment for syphilis, access to commodities, such as male and female condoms and lubricants, and VCT Evidence Sex work and transactional sex have become increasingly important in many countries’ HIV/AIDS epidemics.

17. Scaling up What Works – for Vulnerable Populations (Sex Workers), continued Illustrative services:  Assess the use of presumptive antibiotic treatment of sex workers  Support peer education and outreach programs with sex workers, including gender-based violence and referrals to health, social and legal services  Integrate the SRH needs of sex workers into existing services  Provide referrals to all relevant treatment services  Ensure that pregnant HIV-positive sex workers have access to PMTCT+  Provide or refer sex workers living with HIV to ART, OI, and care and support programmes  Ensure equitable access for HIV-positive sex workers to ART  Institute rights-based programmes to prevent entry into sex work  Support the empowerment of sex workers Illustrative services:  Assess the use of presumptive antibiotic treatment of sex workers  Support peer education and outreach programs with sex workers, including gender-based violence and referrals to health, social and legal services  Integrate the SRH needs of sex workers into existing services  Provide referrals to all relevant treatment services  Ensure that pregnant HIV-positive sex workers have access to PMTCT+  Provide or refer sex workers living with HIV to ART, OI, and care and support programmes  Ensure equitable access for HIV-positive sex workers to ART  Institute rights-based programmes to prevent entry into sex work  Support the empowerment of sex workers Evidence Sex work and transactional sex have become increasingly important in many countries’ HIV/AIDS epidemics.

18. Scaling up What Works – for Vulnerable Populations (MSM) Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for MSM  Promote the targeted and general use of high- quality condoms and water-based lubricants, and ensure their continuing availability  Support safer-sex campaigns and information about HIV transmission modes for MSM  Support peer education and outreach programs with MSM  Promote sexuality education, which includes respect for sexual diversity, gender equality and gender identity  Provide (or refer to) services such as VCT, STI management, tuberculosis and hepatitis C care, harm reduction and drug treatment  Provide or refer MSM with HIV to ART, OI, and care and support programmes Illustrative services:  Organize SRH and all relevant facilities to make them accessible, welcoming, appropriate and affordable for MSM  Promote the targeted and general use of high- quality condoms and water-based lubricants, and ensure their continuing availability  Support safer-sex campaigns and information about HIV transmission modes for MSM  Support peer education and outreach programs with MSM  Promote sexuality education, which includes respect for sexual diversity, gender equality and gender identity  Provide (or refer to) services such as VCT, STI management, tuberculosis and hepatitis C care, harm reduction and drug treatment  Provide or refer MSM with HIV to ART, OI, and care and support programmes Evidence Sex between men is significant because it can involve anal sex, which if unprotected, carries a very high risk of HIV transmission.

19. Scaling up What Works – for Vulnerable Populations (MSM) Illustrative services:  Ensure equitable access for HIV-positive MSM to ART  Provide education, outreach and information campaigns to the female sexual partners of men who have sex with men  Support programming and outreach tailored to the particular needs of sub-groups of men who have sex with men, such as those in the uniformed services, prisoners, male sex workers and those who use drugs  Support the empowerment of MSM Illustrative services:  Ensure equitable access for HIV-positive MSM to ART  Provide education, outreach and information campaigns to the female sexual partners of men who have sex with men  Support programming and outreach tailored to the particular needs of sub-groups of men who have sex with men, such as those in the uniformed services, prisoners, male sex workers and those who use drugs  Support the empowerment of MSM Evidence Sex between men is significant because it can involve anal sex, which if unprotected, carries a very high risk of HIV transmission.

20. Scaling up What Works – for Combating GBV Illustrative services:  Ensure that all HIV and sexual and reproductive health programmes address GBV and adapt services accordingly  Initiate interventions with men/boys to change social norms around gender roles and GBV  Implement a comprehensive approach to reducing GBV, including Community awareness and education; Health sector interventions, including: Screening and referral for HIV infection of victims of rape; Emergency contraception; Forensics examinations; Diagnosis and treatment of STIs; VCT or providing referral to VCT services; and PMTCT services or referral to these services, where appropriate Illustrative services:  Ensure that all HIV and sexual and reproductive health programmes address GBV and adapt services accordingly  Initiate interventions with men/boys to change social norms around gender roles and GBV  Implement a comprehensive approach to reducing GBV, including Community awareness and education; Health sector interventions, including: Screening and referral for HIV infection of victims of rape; Emergency contraception; Forensics examinations; Diagnosis and treatment of STIs; VCT or providing referral to VCT services; and PMTCT services or referral to these services, where appropriate Evidence Gender-based violence correlates strongly with women’s risk of HIV. GBV applies to men as well as women.

21. Scaling up What Works – for Combating GBV Illustrative services:  Implement a comprehensive approach to reducing GBV, including (continued) Education sector interventions such as training education professionals to recognize the signs and symptoms of GBV and to provide counselling and referrals; gender-sensitivity trainings of education professionals to reduce the chance that teachers will become perpetrators of sexual violence; reform of nationally mandated curricula to include gender sensitivity and violence awareness and prevention; and attention to the physical layout of schools so that, for example, girls have private toilet areas; Policy and law reform, including education of parliamentarians and members of the legal system, and consistent and reliable implementation of laws; Income generating projects through microfinance and other related programmes, and literacy classes for women; and Establishment of women-only HIV and GBV support groups and community centres Illustrative services:  Implement a comprehensive approach to reducing GBV, including (continued) Education sector interventions such as training education professionals to recognize the signs and symptoms of GBV and to provide counselling and referrals; gender-sensitivity trainings of education professionals to reduce the chance that teachers will become perpetrators of sexual violence; reform of nationally mandated curricula to include gender sensitivity and violence awareness and prevention; and attention to the physical layout of schools so that, for example, girls have private toilet areas; Policy and law reform, including education of parliamentarians and members of the legal system, and consistent and reliable implementation of laws; Income generating projects through microfinance and other related programmes, and literacy classes for women; and Establishment of women-only HIV and GBV support groups and community centres Evidence Gender-based violence correlates strongly with women’s risk of HIV. GBV applies to men as well as women.