27 March 2013

Africa: Integrating Sexual and Reproductive Health With HIV Services


There is no 'one size fits all' strategy for the development challenges that face the world - and its 7 billion inhabitants - today.

Let's take health for instance, and specifically HIV - a virus that we know affects many millions of people around the world.

In 2012, UNAIDS estimated that there were 34 million people living with HIV, married to, related to, working with, caring for and looked after by many more millions of people around the world.

More than two-thirds of people living with HIV reside in sub-Saharan Africa, which also happens to bear the brunt of global inequality in terms of access to health services, unintended pregnancies and maternal mortality. We know that HIV is mostly sexually transmitted or associated with pregnancy, childbirth and breastfeeding, and is the leading cause of death among women of childbearing age.


There has long been international and national commitment to integration, for example the 2006 United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in New York clearly highlighted the need to strengthen linkages between HIV and sexual and reproductive health (SRH).

This commitment is reflected - and in fact pioneered - in national policies around the world, where strong political leadership continues to be pivotal in strengthening health systems and enabling the provision of good quality health services.

Today, a growing body of evidence is showing that integrating SRH and HIV can reduce stigma, reach out to a 'broader audience' and also increase the uptake of services for a diverse clientele.

This could lead to a reduction in the transmission of HIV, unintended pregnancies, and improvements in maternal health.

It also makes good economic sense - if services are more comprehensive and offer a collaborative approach on treatment and care, then we stand a chance at making the long-term change that we are so desperate to achieve.

The International Planned Parenthood Federation (IPPF) is at the forefront of efforts to ensure that a comprehensive response to HIV is situated within a larger sexual and reproductive health framework.

The IPPF's work links prevention with treatment, care and support, reduces HIV-related stigma and discrimination, and responds to unique regional and national characteristics of the epidemic.

An integrated response from our perspective means that there is an effective approach to helping people realise and make choices about their fertility and promotes family planning and prevents unintended pregnancies.

It enhances the use of HIV-related services and creates the very holistic approach required to meet the desires and needs of clients within the real life contexts of their communities.

The culmination of research

This week sees the conclusion of a five-year operations research programme with the IPPF, the London School of Hygiene and Tropical Medicine (LSHTM) and the Population Council, along with our Member Associations in Kenya, Malawi and Swaziland, known as the Integra Initiative.

This flagship research Initiative, funded by the Bill & Melinda Gates Foundation, has analysed the potential benefits, effectiveness and challenges of integrating HIV and sexual and reproductive health services in Africa, and has built a solid evidence base to inform effective global approaches to some of the most pressing health priorities of today.

It provides insights into the potential of economics, health and social outcomes and models of service provision that can better inform the way HIV testing and prevention, family planning and maternal health services can be delivered in the future.

The results from the Integra Initiative provides evidence that will help guide planners, managers and policymakers towards the greatest value for money - in terms of human rights, health outcomes and cost savings. What we have seen in Malawi is really exciting and we are keen to build on it and share findings with other countries.

In the UK, where IPPF's global headquarters are based, government health and development officials and parliamentarians from across the political divide are closely monitoring this area of research.

The hope is that they can listen to and learn from evaluation of different models of integrating sexual and reproductive health and HIV services. New thinking and new types of investment are needed to transform the national responses to HIV around the world.

This is more than just a robust and scientific research programme. This is research and evidence in reality. It takes on board the country context and demonstrates the challenges that people and health services face on daily basis.

We know people are not getting the high quality and range of affordable and integrated services they need, that should be available to men and women and young people throughout their lives.

Good services need to be supported by good policies, and that's why SRH and HIV integration - which focuses at the service level - needs to be supported by a holistic agenda that incorporates policies, advocacy and community engagement. People need comprehensive approaches because sex and HIV are interrelated.

The importance of saving lives is indisputable; as are the global health benefits of preventing HIV, reducing unintended pregnancies and promoting maternal health. The Integra research results provide an opportunity for evidence informed action. It's time we addressed how this research could make the right changes for men and women and young people everywhere.

The Integra Initiative has been a kind of 'human' science, documenting and evaluating experiences in a real life context that can shape the way health services are delivered everywhere. To go further, now more than ever before, we need real political will and commitment to capitalise on this knowledge.

For more informaton on the Integra Initiative, click here.

About the Authors

Joyce Hilda Banda is the President of Malawi. She is the founder and leader of the People's Party. An educator and grassroots women's rights activist, she was Minister of Foreign Affairs from 2006 to 2009 and vice-president of Malawi from May 2009 to April 2012.

She was previously a Member of Parliament and Minister for Gender, Children's Affairs and Community Services. Banda is also the founder of the Joyce Banda Foundation, the National Association of Business Women, and the Young Women Leaders Network and the Hunger Project.

Director General IPPF

An Ethiopian national, Mr Melesse studied economics at the Catholic University in Louvain, Belgium. He began his career in family planning and reproductive health in 1984 and worked at US-based reproductive health NGO Pathfinder International and IPPF before becoming Director of IPPF's Africa Region. He assumed the position of Director-General on September 1 2011.

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