Sexual and reproductive health activities in HIV programmes: can we monitor progress?

BACKGROUND: Resource allocation and integration of services have been of interest recently to achieve health-related Millennium Development Goals. This paper analyses the extent to which countries receiving funding in HIV were able to invest in activities in the area of sexual and reproductive health (SRH). METHODS: The authors screened the Global Fund grants data with an aggregate investment of US$16 billion in 140 countries to identify indicators revealing typical SRH services. The analysis focused on the 'Top Ten' internationally agreed indicators and used international guidelines and frameworks to define services for SRH and opportunities for 'linkage' between HIV and SRH services. RESULTS: As of December 2008, 238 of all HIV grants (n = 252) from 133 countries included 1620 service delivery indicators related to SRH. The budgets amounted to US$9.1 billion with US$5.9 billion committed and US$4 billion disbursed. Services included (1) prevention of mother to child transmission for 445,000 HIV-positive pregnant women, (2) 5.7 million care and support services, (3) 1.2 billion condoms delivered, (4) 4.4 million episodes of sexually transmitted infections treated, (5) 61 million counselling and testing encounters, and (6) 11.6 million behavioural change communication (BCC) outreach services for people at high risk and 64.5 million BCC activities for the general population, including youth. Information on the linkage and integration of SRH-HIV services was limited. CONCLUSION: Around 94% of HIV programmes supported SRH-related activities. However, there is a need to systematically capture data on SRH-HIV service integration to understand the benefits of linking these services.

Linking HIV and sexual and reproductive health services to enhance program outcomes.

Sexual and reproductive health services provide an opportunity to achieve universal access to HIV prevention and care and should be part of a national strategic response. There is recognition that HIV is a sexually transmitted infection or associated with pregnancy, childbirth, and breastfeeding. Both address the same target population and the vulnerability to risk and underlying causes are essentially the same. Providing comprehensive services that prevent HIV transmission, including to infants, those that meet the fertility intentions of people living with HIV, and management and prevention of sexually transmitted infections are some of the key elements of these linkages. Approaches that have shown success in HIV prevention and care include those in which a combination of strategies has been deployed, both in prevention and treatment regimens, and the combination of services delivery should yield equally positive results. Some strategies and recommendations detailed at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in 2009 are discussed that could increase the effective response to the global response to HIV.