When a young woman visits the GP, the health centre or the pharmacy, she doesn’t think about her health in separate boxes that correspond with the international development sector’s budget lines or sector codes. She won’t think of HIV and STIs as separate to contraception or abortion. She’ll think about having a happy and pleasurable sex life, of having children, or not having children and of staying healthy; all in one breath.
And so, the services that aim to reach girls and women need to do the same.
In 2015, young women (aged 15-24) accounted for 20% of new HIV infections – despite making up just 11% of the population. Today, 214 million women continue to have an unmet need for family planning. The disproportionate impact of HIV on women and girls, and the unmet need for family planning are challenges that both stem from underlying gender inequality. Gender inequality limits women and girls’ decision making related to their own health and restricts access to sexual and reproductive health and rights.
Addressing HIV and family planning together within a cohesive package of sexual and reproductive health and rights (SRHR) services acknowledges the similar structural drivers and presents an opportunity to more effectively meet women and girls’ holistic needs. Integrating services is also an opportunity to reach more women and girls by reducing barriers to access – like paying for transport to the nearest clinic, getting the afternoon off from work or finding child care.
Of course, integrating services can be challenging, and a key risk is that we ask service providers to take on more and more responsibilities with the same level of resources. Successful integration will start with increased resources and training on how to provide human rights based, stigma and discrimination free care. It will also ensure that key populations most affected by HIV (including sex workers, men who have sex with men, transgender people and people who use drugs) are meaningfully involved in the programmes design, implementation and monitoring. As we integrate programmes we also have to ensure we have the right systems in place to ensure nothing falls through the cracks and that we can continue to robustly monitor outcomes.
Over the last few months, STOPAIDS members have been working to develop a good practice guidance resource on HIV, Women and Reproductive Choices. The resource is based on the RAISE framework, which STOPAIDS developed in 2012 and highlights Rights, Access, Investment, Security and Equity as important principles when integrating women’s health interventions. The resource includes case studies from STOPAIDS members: Salamander Trust, The International HIV/AIDS Alliance, Chasing Zero and International Planned Parenthood Federation and was co- written with the Athena Network.
We launched the factsheet in the lead up to the UK Government Family Planning Summit, which Mike and I attended on behalf of STOPAIDS. The Summit aimed to gather lessons learned, re-energise commitment and involve new partners on the road to achieving the family planning 2020 goals.
At the Summit, I heard some very positive indications from the Secretary of State Priti Patel on the UK’s commitment to providing a comprehensive package of SRHR services for girls and women globally.
Priti Patel said, ‘[Family Planning] can never be done in isolation…we have to link this and knit [family planning] together with the wider investment when it comes to education for girls, maternal health, women’s economic empowerment, preventing HIV/AIDS, ending violence against women and girls including FGM and child marriage’.
Priti Patel’s statement is a welcome acknowledgement of the diversity and complexity of women and girls’ lives.
DFID are now looking to refreshing their Strategic Vision on Women and Girls. As the number one killer of women of a reproductive age, HIV must be included within this updated Strategic Vision.
We’ve heard encouraging indications from DFID that achieving access to universal sexual and reproductive health and rights will be a central pillar to this strategy and that HIV is expected to be a component within this.
Within this pillar DFID must consider the full range of women and girls’ sexual and reproductive health needs, rights and desires. The Action for Global Health UK Network and the UK Sexual and Reproductive Health & Rights Network released a joint statement in the lead up to the Family Planning Summit outlining the key components of a comprehensive SRHR package – including STI services, HIV services, comprehensive sexuality education, youth friendly services, universal access to safe abortion and post abortion care.
The Strategic Vision on Women and Girls can then guide DFID’s country office programmes and DFID’s investments through multilateral organisations to achieve better outcomes for women and girls.
Alysa Remtulla, Policy Officer