Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda.

BACKGROUND: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research adequately address the SRH rights, priorities and HIV risks of adolescent girls and young women in emergency settings? What are the missed opportunities for holistically addressing the vulnerabilities experienced by those living with HIV during rapid onset disasters and long term, protracted emergencies? Authors review considerations informing real-time decision making, and highlight missed opportunities to apply a gendered lens in the delivery of AGYW-centered SRHR/HIV services. METHODS: A scoping review identified studies on HIV intervention and outcomes in emergency settings, published in the peer-reviewed literature (2002-2017). This exercise was complemented with a desk review of normative guidance, frameworks, and implementation guidelines on HIV and SRH in emergency responses, and by consultations with subject matter experts. RESULTS: The existing frameworks and guidance pay scant attention to the sexual reproductive health and rights of young women living with HIV (WLHIV), focusing mainly on prevention of mother to child transmission (PMTCT), antiretroviral therapy (ART), HIV testing services, and linkage to treatment services. Applying a gendered sexual and reproductive health lens to the response offers opportunities to identify critical implementation questions, and highlight promising practices, to better tailor current services for AGYW. CONCLUSIONS: A plurality of competing needs crowds out dedicated time and space to effectively integrate HIV and sexual and reproductive health interventions in emergency settings. Political will is required to advance multi-sectoral cooperation, through joint planning, rights-informed learning and integrative responses, and to promote creative solutions for ART continuation, drug supply and HIV testing, treatment and care. Recent advancements in policy and practice would suggest that a more AGYW-centered response is feasible.

The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration.

INTRODUCTION: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. DISCUSSION: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. CONCLUSION: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling.