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Barriers to realising sexual and reproductive health and rights (SRHR) and to accessing HIV prevention, treatment and care share similar and overlapping roots. A lack of access to SRHR increases people’s vulnerability to HIV, and vice versa.
HIV acquisition itself also acts as a further barrier to realising SRHR, as do a number of factors including stigma, discrimination and marginalisation on the basis of age, gender, sexual orientation and gender identity.
Evidence shows that good access to SRHR services, and an environment that upholds, protects and respects the rights of all people, helps to prevent new HIV infections and enables those living with HIV in all their diversity to live full and productive lives.
Joining up services relating to HIV and SRHR can increase people’s ability to access and take up these services, while addressing the violation of people’s SRHR by promoting and protecting their rights can also reduce their vulnerability to HIV.
We work with people living with and most affected by HIV to improve the quality of services so that everyone has access to tailored, gender sensitive, rights-based and rights-enhancing, quality SRHR and HIV services, delivered by knowledgeable, non-judgemental service providers, and where all people are treated with dignity and respect, free from stigma, discrimination, coercion or violence.
To achieve this, our approach to HIV and SRHR programming is based on the following key areas:
Integrated approaches to SRHR and HIV
Most people think about their sexual and reproductive lives in a holistic way, with HIV as only one aspect. As a result, HIV and SRHR have become inextricably linked across our work; we recognise the multifaceted ways in which integrating SRHR into HIV interventions all along the HIV prevention-treatment-care continuum strengthens the HIV response.
Our programmatic approach to SRHR includes a number of key interventions and activities including comprehensive sexuality education; integrated safer sex promotion to prevent sexually transmitted infections (STIs), HIV and unintended pregnancy; integrated family planning and HIV services; protecting and enhancing fertility for people living with and most affected by HIV; improving maternal and newborn health; the prevention, diagnosis and treatment of SRH-related cancers; and preventing and addressing gender-based violence.
Rights based and community-owned
Central to our approach is the meaningful involvement of people most affected by, and living with, HIV in designing, implementing, delivering and evaluating our HIV and SRHR programmes.
This means enabling people from key populations, women and girls, and adolescents and young people to be at the forefront of sustainable, community-led and community-owned responses that are grounded in real-life experiences, priorities and preferences.
Coordinating change at multiple levels
Our work addresses the drivers of sexual and reproductive ill health across all levels of society.
At the level of the individual we build people’s knowledge, resilience and agency so they are able to enact healthy choices around their SRHR which respond to their own needs and priorities, including family planning, HIV testing, prevention, treatment and retention in care.
The impact of this often spreads further than the individual, affecting change among peers, sexual partners, families and households.
At the community level we work to change the factors that undermine SRHR, including stigma, discrimination, marginalising social attitudes, gender inequality and gender-based violence. We do this by engaging community leaders, parents, teachers, religious and traditional leaders and police, and by building the capacity and resilience of civil society, community-based organisations and networks of people living with and most affected by HIV to deliver effective HIV/SRHR programmes and advocacy.
At the service level we work with health centres, hospitals, community-based outreach services and traditional services to foster non-judgemental environments and develop HIV and SRHR services that are accessible, responsive, affordable, user-friendly, good quality and integrated. A key part of this is empowering people living with and most affected by HIV to work with health providers to reduce stigma and discrimination.
Where existing political and structural contexts violate human rights or stigmatise and discriminate against people living with and most affected by HIV, we advocate for laws and policies that support SRHR and gender equality and protect people from harassment and abuse.
- Link Up has enabled almost 1 million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda to take control of their SRHR. Running between 2013 and 2016, this US $45 million project, which was led by the Alliance and a consortium of partners, demonstrates that young people most affected by HIV can take ownership of their own health and access a broad range of SRHR services if they are provided with the space and the resources to do so.
- The Alliance is collaborating with other organisations to expand our work with adolescents and young people and has started implementing a portfolio of projects called READY. READY stands for Resilient & Empowered Adolescents & Young People. Below is a description of two of the projects that are udnerway.
- READY+ is a four-year programme in southern Africa that will reach 30,000 adolescents and young people living with HIV in Mozambique, Swaziland, Tanzania, and Zimbabwe. It will provide HIV and SRHR education, peer support and high quality integrated HIV/SRHR and mental health services. It will also support young people to participate in local, national, and global SRH/HIV advocacy activities to address structural barriers to accessing SRH services and realising their sexual and reproductive rights.
- READY Teens focuses on 10-19 year olds living with and most affected by HIV in Burundi, Ethiopia and Uganda. The project particularly recognises the vulnerabilities and marginalisation experienced by adolescents from key populations, including adolescents living with HIV, selling sex, using drugs and from sexual minorities.
- Uganda SRHR Umbrella is a five-year (2016-2021) US $13 million programme that will build the capacity of non-governmental organisations and community-based organisations to deliver quality services for communities that have unmet SRHR needs and are highly vulnerable to HIV. These target communities include children (aged 10-14), adolescents and young people, people living with HIV, and key populations including men who have sex with men, sex workers, boda boda drivers, truckers and fisher-folks.
- Partnership to Inspire, Transform and Connect the HIV response (PITCH) is a is a four-year (2016-2020) strategic collaboration between Aids Fonds/STOP AIDS NOW!, the Alliance and the Dutch Ministry of Foreign Affairs will work in Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Uganda, Ukraine, Vietnam and Zimbabwe. The project strengthens the capacity of local civil society organisations to advocate for equal access to SRHR service for those most affected by HIV, and decriminalisation for key population.
- In 2016, 950,000 people were reached with integrated HIV/SRHR services. During this period, our integrated HIV and SRHR coverage expanded from 23 to 26 countries.
- Results from Link Up are illustrative of our approach and achievements in this area. In total, the programme reached nearly 1 million young people (aged 10 – 24) most affected by, and living with HIV, with SRHR and HIV information, commodities and services. Altogether, nearly 400,000 young people accessed integrated SRHR and HIV services, with more than 248,100 young people accessing family planning in combination with HIV services. Of these, 84,800 were aged 10 – 19.
This good practice guide brings together expertise from the Alliance global community, research and other key external materials on the integration of HIV and SRHR services. It contains information, strategies and resources, which define Alliance Good Practice Programming Standards, on how to programme integrated HIV and SRHR services in an effective manner.
A guide to facilitating a workshop on linking up HIV and SRHR with young key populations. This 101 training programme on SRHR and HIV integration outlines a five day course designed to make service providers more aware of the needs of young people who sell sex, young people living with HIV, young men who have sex with men and young transgender people. Its aim is to decrease stigma and increase client satisfaction.
This facilitator’s guide presents a four-day workshop designed to develop a common understanding on how to integrate HIV and SRHR, and enables participants to explore the benefits and challenges of integration.
These key resources have been developed to help those looking to enable young people most affected by HIV to understand and claim their SRHR and access youth-friendly, integrated services.
In this report, young people from around the world living with and most affected by HIV champion their vision for realising and claiming their SRHR and setting their priorities for HIV and SRHR integration.