1. www.aids2010.org The Global Context of Sexual and Reproductive Health & HIV: Making seamless programmes and services a reality for PLHIV Breaking down the operational and logistical barriers Lynn Collins (UNFPA) and Kevin Osborne (IPPF)

2. www.aids2010.org “Integration is not itself an end but a means to achieve…” Universal access goals Health outcomes Human rights Programme effectiveness/efficiency Link between community and health interventions Elimination of stigma and discrimination Slide from UNAIDS PCB Thematic Session on SRH HIV Linkages 21 June 2010

3. 3 www.aids2010.org Funding for Wider Health Initiatives

4. The U.S. Government’s Global Health Initiative “ We will not be successful in our efforts to end deaths from AIDS, malaria, and tuberculosis unless we do more to improve health systems around the world, focus our efforts on child and maternal health, and ensure that best practices drive the funding for these programs.”—President Obama, May 5, 2009 Linkages Funding Opportunities GHI www.aids2010.org www.globalhealth.gov/initiatives/05192010b.ppt

5. 5 d. Reduce the risks and vulnerabilities that increase women’s and girls’ susceptibility to infection by the three diseases, and mitigate the impact for those already infected (Including, gender-based violence, female genital mutilation, early or forced marriage, lack of access to education, wife inheritance, increased risk due to pregnancy, discrimination in employment, etc.) f. Include programs that empower women and girls so they can protect themselves, by having access to sexual and reproductive health care (SRH), access to female controlled prevention measures (female condom, negotiating condom-use etc.), and access to education. In this context the Global Fund will champion activities that strengthen SRH-HIV/AIDS service integration. www.aids2010.org Linkages Funding Opportunities GF http://www.theglobalfund.org/documents/strategy/TheGenderEqualityStrategy_en.pdf

6. Funding has driven by artificial separation of SRH & HIV ‘Shift in the balance of power’ - country ownership for contextual solutions vs. restrictive/conditionality of donors Objective is a comprehensive responsive to clients Importance of global voices, especially around human rights, e.g. engagement principles “What we need most is integration of donors!” www.aids2010.org Slide based on UNAIDS PCB Thematic Session on SRH HIV Linkages 21 June 2010

7. 7 Allows continuity of care without being externally referred Expands range of clinical services beyond ARVs Reduces frequency/costs of appointments Reduces HIV related stigma and discrimination Provides increased coverage for key populations Promotes an increased culture of rights Linkages benefits for People Living with HIV www.aids2010.org

8. Rapid Assessment Tool for SRH and HIV Linkages  Assesses HIV and SRH bi- directional linkages - policy, systems, and service-delivery  Identifies current critical gaps  Contributes to the development of country-specific action plans to strengthen linkages.  Focuses primarily on health sector www.aids2010.org

9.  Stand-alone activity or part of larger review  Includes desk reviews & individual/group interviews  Ensure at a minimum the assessment team includes:  national government SRH and HIV units  networks of people living with HIV  key populations  civil society  UN organizations  donors  Estimated timeframe: 3 months  Appendix 3. Budget for Estimating Cost: USD 30 – 50K  Appendix 5. Next Steps for Utilization of Findings Implementation - Rapid Assessment Tool www.aids2010.org

10. Rapid Assessment Tool Africa Benin Botswana Burkina Faso Cote D'Ivoire Malawi Swaziland Tanzania Uganda Latin America and Caribbean Belize Eastern Europe and Central Asia Kyrgyzstan Russian Federation Arab States Lebanon Morocco Tunisia Asia and Pacific Pakistan Viet Nam Roll-out conducted in 16 countries in 5 regions www.aids2010.org Available languages: Arabic, English, French, Russian and Spanish

11. Insufficient attention to the full scope of linkages issues (legislative, socio- economic, cultural) Weak links btn natl’ AIDS & SRH strategies& plans Vertical programming based on separate funding streams Poor linkages btn health and other sectors education, gender, economic No linkages strategy & implementation plan Absence linkages in national dev./health strategies www.aids2010.org Linkages Barriers - Policy

12. Conditionality in funding Laws and policies on rights requiring reform (e.g. age of consent for services; human rights, gender equality, age at marriage, gender- based violence, discrimination, treatment access, criminalisation, etc.) Lack of awareness of rights to health and non-discrimination Multiple obstacles to SRH and HIV service access for PLHIV and key populations Low level of male engagement in SRH and HIV Avoidance of sensitive issues www.aids2010.org Linkages Barriers – Policy cont.

13. Weak coordination mechanisms Underutilized joint capacity building Absence of shared monitoring and evaluation systems Weak health systems Inadequate links with community Insufficient integration of PMTCT into SRH, including family planning Weak capacity and inadequate engagement of PLHIV, key populations, etc. Lack of commodities & equipment www.aids2010.org Linkages Barriers - Systems

14. Inadequate human resources/support Stigma and discrimination toward people living with HIV and key populations, by and toward health providers Overburdening of health providers Attrition of health providers Lack of capacity to cope with increased numbers of clients Weak capacity building for multi- tasking and task- shifting (need for new knowledge, skills, and non-judgemental attitudes) www.aids2010.org Linkages Barriers - Services

15. www.aids2010.org Moving the rights agenda along Recognize service integration is not a panacea Go beyond the health sector Support research to address key gaps (e.g. linkages in low/concentrated epidemics, etc.) Keep stigma and discrimination high on the agenda Support legal & policy reform, remove punitive laws Direct funding & better engage community/civil society to achieve universal access