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Linkages between SRH and HIV/AIDS

Linkages between SRH and HIV/AIDS. Jane Cottingham World Health Organization Women and HIV/AIDS in CEE: bringing different communities together to advance common goals Warsaw, Poland, 11-12 November 2005. Some imperatives (1). ICPD + 5, 1999:

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Linkages between SRH and HIV/AIDS

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  1. Linkages between SRH and HIV/AIDS Jane Cottingham World Health Organization Women and HIV/AIDS in CEE: bringing different communities together to advance common goals Warsaw, Poland, 11-12 November 2005 05_JCSTAG_FEB1

  2. Some imperatives (1) ICPD + 5, 1999: • Provide information, counselling and services to provide safe and effective contraceptive methods; • Ensure women's access to comprehensive obstetric care; • Ensure services for STIs and HIV/AIDS are an integral component of reproductive and sexual health programmes at primary health care level; • Train and equip health service providers and take other measures to ensure that abortion is safe and accessible (in circumstances where not against the law). Key actions for the further implementation of the Programme of Action of the ICPD. United Nations, New York, 1999, paragraphs 5757(a), 62(b), 63(iii) and 68. 05_JCSTAG_FEB2

  3. Some imperatives (2) UN Declaration of Commitment on HIV/AIDS, 2001 • Increase capacities of women and adolescent girls to protect themselves from the risk of HIV infection through provision of health services – including SRH services • Take an integrated, comprehensive approach where prevention, care, support and treatment for those infected and affected by HIV are mutually reinforcing elements • Expand good-quality, youth-friendly information and sexual health education and counselling services. United Nations General Assembly Twenty-Sixth Special Session. Document A/RES/S-26/2, adopted 27 June 2001, paragraphs 7, 60, 63. 05_JCSTAG_FEB3

  4. Some imperatives (3) Millennium Development Goals (2001) • Reduce child mortality • Improve women's health • Combat HIV/AIDS, malaria and other diseases • Promote gender equality and empower women United Nations, Department of Public Information, 2005. 05_JCSTAG_FEB4

  5. Some imperatives (4) Commission on Population and Development, 2005 • Encourages UNFPA, UNAIDS and other agencies to continue to implement HIV prevention strategies, recognizing that sexual and reproductive health programmes are key entry points for HIV prevention, and taking into account the need for a comprehensive approach to prevention and treatment. United Nations, CPD Resolution on Population, development and HIV/AIDS with particular emphasis on poverty. E/CN.9/2005/L.4. 2005, paragraph 25. 05_JCSTAG_FEB5

  6. Key issues for linkages • Impact of HIV/AIDS on reproductive health • Impact of HIV/AIDS on sexual health • Role of SRH services in HIV prevention and treatment • Role of HIV/AIDS prevention and treatment services in addressing SRH needs • Linking HIV prevention with care, support and treatment, and with improved SRH 05_JCSTAG_FEB6

  7. Impact of HIV/AIDS on reproductive health (1) • HIV/AIDS fundamentally changes the experience of pregnancy and delivery – decisions, fear of infection and transmission to the infant, fear of disclosure to partners and family, pressure to have or not have children. • Pregnancy does not appear to have a significant effect on HIV disease progression (in developed countries, Thailand). • In some African countries mortality in HIV-positive women is higher in the late post-partum period. 05_JCSTAG_FEB7

  8. Impact of HIV/AIDS on reproductive health (2) • Pregnant and post-partum women have been found to be at increased risk of HIV infection because their partners may have unsafe sex outside the relationship. • Women living with HIV may be more susceptible to obstetric complications (PPH, sepsis, C-section, complications of unsafe abortion). • Opportunistic infections or co-infections such a malaria, tuberculosis, progress faster during pregnancy. • Appropriate use of ARV treatment in pregnant HIV-positive women is reducing the rates of AIDS-related maternal and perinatal mortality and morbidity. 05_JCSTAG_FEB8

  9. Impact of HIV/AIDS on reproductive health (3) • The risk of mother (parent) to child transmission of HIV is 15-30% in non-breastfeeding populations (no ARV therapy). • Breastfeeding by a woman with HIV increases the risk by 5-20% to a total of 20-45%. • In Brazil, Europe and the USA, triple-ARV combinations are given during pregnancy and labour and have reduced MTCT rates to below 2% among women avoiding breastfeeding. 05_JCSTAG_FEB9

  10. Impact of HIV/AIDS on reproductive health (4) • Decision to terminate a pregnancy: more HIV-positive women decide to terminate. • Women with HIV may be (a) under greater pressure to abort ("they shouldn't be having children anyway"); and (b) unable to obtain an abortion because of stigma. • Both surgical and medical methods of abortion are safe; women with HIV more likely to have anaemia making them less able to resist infections or to survive haemorrhage. • Women with HIV may be at greater risk of developing serious complications including septicaemia following unsafe abortion. 05_JCSTAG_FEB10

  11. Impact of HIV/AIDS on sexual health: sexuality • Decreased sexual desire or satisfaction • Feelings of guilt or shame • Negative association of sex with HIV • Resentment towards a sexual partner • Ill-health or psychological stress may interfere • Potential increase in vulnerability to sexual violence and STI • Infertility 05_JCSTAG_FEB11

  12. Impact of HIV/AIDS on sexual health: STIs • STIs increase the risk of HIV infection in both men and women by 3-5 times. • The presence of HIV makes STIs and other RTIs more severe and difficult to treat. • Syphilis, gonorrhoea and chlamydia can all have adverse effects on pregnancy outcomes and on newborns. 05_JCSTAG_FEB12

  13. Impact of HIV/AIDS on sexual health: contraception • Most contraceptive methods are safe and effective for use by women with asymptomatic HIV infection and women with AIDS; but • Women and their partners are strongly encouraged to protect against unintended pregnancy, STI and HIV by using condoms alone or in addition to another contraceptive method (WHO statement 9/2005). • ARV drugs may decrease or increase effectiveness of hormonal contraceptives, and vice-versa. Consistent use of condoms recommended for woman on ARV. 05_JCSTAG_FEB13

  14. Association of VAW and HIV Forced sex may directly increase women’s risk for HIV • HIV-positive women have experienced more sexual coercion than HIV-negative women • HIV risk factors are associated with sexual coercion (lack of decision-making, young age) • Women who are raped are at substantially increased risk of acquiring an STI 05_JCSTAG_FEB14

  15. Association of VAW and HIV HIV testing & disclosure of serostatus may increase women’s risk for violence • The majority of women who disclose report supportive reactions • 10%-25% of women report negative reactions • A major reason for non-disclosure is fear of partner’s reaction 05_JCSTAG_FEB15

  16. Role of SRH services in HIV prevention and treatment (1) Primary prevention of HIV through SRH programmes: • FP and emergency contraception services • Antenatal, delivery and post-partum care • Post-abortion care and abortion services • Cervical cancer screening and treatment services • STI screening and treatment services • Infertility services • Sexual violence services • Sexual health services for men • Youth-friendly services 05_JCSTAG_FEB16

  17. Role of SRH services in HIV prevention and treatment (2) • Carry out voluntary HIV counselling and testing • Offer condoms • Give advice on forms of safer sex • Dual protection to prevent STI/HIV and unwanted pregnancy • Use of condoms to protect women and their partners during pregnancy and breastfeeding • Use of condoms outside primary partnerships • Reducing number of sexual partners • Mutual monogamy • Non-penetrative sex • Delaying sexual debut • Not having sex • Skills to negotiate protection and refuse unwanted/unsafe sex 05_JCSTAG_FEB17

  18. Role of SRH services in HIV prevention and treatment (3) Positive prevention and treatment • Antenatal care and childbirth services • Short-course ARV treatment to prevent MTCT • Counselling on infant feeding alternatives • Family planning, STI services and others • Referrals to HIV treatment services 05_JCSTAG_FEB18

  19. Role of HIV/AIDS prevention and treatment services in addressing SRH needs • Current HIV services include: • ARV therapy • Management of opportunistic infections • Treatment of important co-infections (TB, malaria) • Treatment of other conditions (STIs, hep A and B, cervical cancer, anaemia) • Adequate nutrition Additionally, HIV services could provide: • Contraceptive information and advice • Integrated pregnancy and childbirth care • Advice for men (fathers) as well as women on protecting infants 05_JCSTAG_FEB19

  20. Linking HIV prevention with care, support and treatment, and with improved SRH • Increasing access to HIV testing through VCT and SRH services is the gateway to the continuum of HIV prevention, care, support and treatment. • People need support to practise HIV prevention over a long period of time, which requires – • An enabling and supportive environment that • Promotes and protects rights for those living with HIV/AIDS, including their families • Provides the interventions that mitigate the impact of AIDS on families and communities • Removes the stigma that prevents appropriate care and support 05_JCSTAG_FEB20

  21. Linking HIV prevention with care, support and treatment, and with improved SRH Some of the human rights relevant to SRH and HIV: • Right to non-discrimination • Right to life, survival and security • Right to the highest attainable standard of health • Rights to education and information • Right to marry and found a family • Right to the benefits of scientific progress • Right to be free from torture, and from inhuman and degrading treatment • Right to decide the number and timing of one's children 05_JCSTAG_FEB21

  22. Some priority linkages (IPPF, UNFPA, WHO) • Learn HIV status • Support legal/policy reform to remove barriers for young people's access to information, counselling, testing • Promote safer sex • Comprehensive safer sex services to PLWHA • Optimize connection between HIV and STI services • Implement a package of HIV services in STI programmes • Integrate HIV with maternal and infant health • Strengthen maternal health services for women living with HIV/AIDS 05_JCSTAG_FEB22

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