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UNAIDS Regional Support Team, Eastern and Southern Africa

Overview and Trends on HIV and SRHR linkages- UNAIDS, RST ESA. Lawrence Mashimbye. UNAIDS Regional Support Team, Eastern and Southern Africa. Presentation Outline. HIV data and statistics Ending AIDS by 2030 & Fast-Track targets (90-90-90) SRH/HIV linkages – definition, concepts & models

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UNAIDS Regional Support Team, Eastern and Southern Africa

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  1. Overview and Trends on HIV and SRHR linkages- UNAIDS, RST ESA Lawrence Mashimbye UNAIDS Regional Support Team, Eastern and Southern Africa

  2. Presentation Outline • HIV data and statistics • Ending AIDS by 2030 & Fast-Track targets (90-90-90) • SRH/HIV linkages – definition, concepts & models • Rationale for SRH/HIV integration • SRHR/HIV linkages - literature • SRHR/HIV linkages - promising practices • SRHR/HIV linkages - emerging priorities

  3. Number of people living with HIV by 2014 Globally, 36.9 Million people living with HIV In SSA, 25.8 million people living with HIV

  4. New HIV infection in 2014 3.4 million 2.0 Million 41% decline Globally 2014 2001 1.4 million SSA 70% of new HIV infections in SSA in 2014 2014

  5. Is there ‘Hope’ in the fight against HIV? • Treatment • Globally, treatment coverage is at 40% • Treatment coverage in the Eastern and Southern Africa region is at 47% • AIDS related death • Globally, AIDS related death fell from 1.5 million in 2011 to 1.2 million in 2014 • In ESA, the number of AIDS related death fell from 730 000 in 2011 to 460 000 in 2014

  6. Ending AIDS by 2030

  7. Ending AIDS by 2030

  8. Ending AIDS by 2030

  9. SRH/HIV linkages – definitions, concepts & models Linkages: The policy, programmatic, services and advocacy synergies between sexual and reproductive health and HIV/AIDS. Integration: Refers to different kinds of sexual and reproductive health and HIV/AIDS services or operational programmes that can be joined together to ensure collective outcomes. This would include referrals from one service to another. It is based on the need to offer comprehensive services. WHO, UNAIDS, UNFPA, WHO (2008). Gateways to integration: a case study series.

  10. SRH/HIV linkages – definitions, concepts & models • unidirectional integration of SRH services into HIV, such as provision of contraceptives in HIV counseling and testing; • unidirectional integration of HIV services into SRH, such as HIV • treatment with antenatal care and postpartum services; and • bidirectional integration • WHO, UNAIDS, UNFPA, WHO (2008). Gateways to integration: a case study series.

  11. SRH/HIV linkages – definitions, concepts & models • “one stop service delivery model” - service provided by one service provider in the same room • “supermarket model”- service provided by different service providers in different rooms, but same building • “mall model”- service provided by different service providers in different building, but same health facility

  12. Rationale for SRH/HIV integration • Majority of HIV infections • - sexually transmitted, or • - associated with pregnancy, childbirth & breastfeeding • Common root causes • Poverty, Gender inequality, Gender-based violence, Human rights violations, Stigma and discrimination • Benefits • Improved access to and uptake of key HIV and SRH services • Meet SRH needs of people living with HIV • Reduce HIV-related stigma and discrimination • Better understanding and protection of individuals’ rights • Better utilisation of scarce resources for health

  13. SRH/HIV linkages – literature overview Birdthistle I et al (2013) ‘Integration of HIV and maternal healthcare in a high HIV-prevalence setting: analysis of client flow data over time in Swaziland’ ‘Provision of HIV/STI services with MCH care occurred at all facilities, yet relatively few women receive integrated services. Increases in integration were driven by increases in HIV counselling, while sharp declines in some facilities indicate that integration is difficult to sustain. Opportunities for intensifying HIV integration lie with ANC, CH and FP, while HIV-PNC integration will remain limited until more women attend PNC.’

  14. SRH/HIV linkages – literature overview Church et al (2012) ‘The Relationship Between Service Integration and Client Satisfaction: A Mixed Methods Case Study Within HIV Services in a High Prevalence Setting in Africa’ ‘This study has demonstrated that relationship between integrated care and client satisfaction is complex and multifaceted. While the quantitative survey demonstrated a significant association between clinic model and satisfaction score, the effect was not as anticipated since there was no difference in satisfaction between those in the most standalone clinic and the most integrated clinic’

  15. SRH/HIV linkages – literature overview Ndwiga et al (2014) ‘Exploring experiences in peer mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in Kenya’ ‘Mentoring was perceived by both mentors and mentees as a sustainable method for capacity building, which increased providers’ ability to offer a wide range of and improved access to integrated SRH and HIV services.’

  16. SRH/HIV linkages – literature overview Kennedy CE et al (2014) ‘Linking sexual and reproductive health and HIV interventions: a systematic review’ Analyzed 35 studies published 1990 – 2007 ‘Existing evidence provides support for linkages, although significant gaps in the literature remain. Policy makers, programme managers and researchers should continue to advocate for, support, implement and rigorously evaluate SRH and HIV linkages at the policy, systems and service levels.’

  17. SRHR/HIV linkages – promising practices • Integra Initiative • Kenya, Swaziland, Malawi, • http://www.integrainitiative.org • UNFPA and UNAIDS Joint initiative on SRH/HIV linkages in 7 SADC countries (2011 - 2015) • Botswana, Lesotho, Malawi, Namibia, Swaziland, Zambia, Zimbabwe • http://www.integrainitiative.org/resources

  18. SRHR/HIV linkages – promising practices A video of Malawi

  19. SRHR/HIV linkages – emerging priorities • Sustainable Development Goals (SDGs) ‘Goal 3: ensuring healthy life and promote well-being for all at all ages’ • HIV and AIDS • TB, • Malaria, • Gender-based Inequality • WHO guidelines on HIV treatment – Test & Treat • Minimum Standards for Integrating HIV and AIDS/Sexual Reproductive Health • SADC Integrated HIV, SRH, TB and Malaria strategy • UNFPA and UNAIDS joint initiative on SRHR/HIV linkages, linkages with GBV, TB and Malaria in 10 countries in the ESA region (2nd phase)

  20. Thank you

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