How linked are national HIV and SRHR strategies? A review of SRHR and HIV strategies in 60 countries

Abstract

The connection between HIV and sexual and reproductive health and rights (SRHR) is widely recognised along with the benefits of linking them at the legal/policy, health systems, and service delivery levels. However, despite increased rhetoric about the need for this three-tiered approach, integrated service delivery has not been fully addressed at the legal/policy level through national strategies. Thus a review of HIV and SRHR strategies was conducted for 60 countries, determining the extent to which they reflected the intersections between HIV and SRHR. Each HIV strategy was scored on whether five key SRHR components were incorporated and had an associated measurable target. SRHR strategies were similarly assessed for incorporation of five HIV components and associated targets. HIV strategies had a higher level of inclusion of SRHR components with a global average of 6.6/10 compared to 3.7/10 for SRHR strategies. The highest scoring component was the elimination of mother-to-child transmission of HIV (EMTCT) and the lowest was SRHR of people living with HIV. Countries with higher scores in one strategy tended to have higher scores in the other but there was no difference over time. Whilst there has been increased global commitment since 2004 to link SRHR and HIV, insufficient headway has been made in linking related national strategies. Although EMTCT is included with targets in the majority of HIV and SRHR strategies, the broader SRHR needs of women living with HIV are not. Also, condoms are not being considered an effective triple protection tool. HIV and SRHR strategies provide direction and targets which ultimately may influence funding and vice versa. Therefore, it is essential that these strategies are right-based and incorporate the key connections between SRHR and HIV with measurable targets to realise the full benefits of a joint response.

Challenges to generating political prioritization for adolescent sexual and reproductive health in Kenya: A qualitative study

“…This collective action has resulted in the integration of adolescent SRH into national policy documents and guidelines across different sectors, such as education, youth, health, and agriculture. However, the presence of normative guidance in the form of national policy documents and guidelines has not always promoted political priority nor deliberate action that advances a shared agenda [52]. Within the life cycle model of how norms advance through a system to become an established priority, it is possible for some norms to be internalized and taken for granted to the extent that they are no longer discussed as an issue [53].…”

The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services

“…Governments elsewhere are promoting integration but have not ensured SRH and HIV strategies and policies are aligned accordingly, leading to an ad hoc approach to integrated service delivery and placing a greater burden on frontline health workers (Hope et al. ; Hopkins and Collins ). Further research on integrated SRH‐HIV services within health systems is urgently needed to inform the planning, financing, and coordination of integrated service delivery (Hope et al.…”

“…Initiatives such as the SRHR and HIV Linkages project in seven countries in Southern Africa (UNFPA and UNAIDS 2015) show increased impetus for scaling up SRH and rights and HIV integration, especially linking SRH and rights and HIV at the policy, health system, and service-delivery levels. Governments elsewhere are promoting integration but have not ensured SRH and HIV strategies and policies are aligned accordingly, leading to an ad hoc approach to integrated service delivery and placing a greater burden on frontline health workers (Hope et al 2014;Hopkins and Collins 2017). Further research on integrated SRH-HIV services within health systems is urgently needed to inform the planning, financing, and coordination of integrated service delivery (Hope et al 2014).…”

Integration of HIV and reproductive health services in public sector facilities: analysis of client flow data over time in Kenya

“…Since then, research—including two journal supplements on integration of RH and HIV services—has widened the knowledge base (most recently, the Health Policy and Planning supplement, 2017). Integration at policy level remains surprisingly weak 8 and the need for systems-wide approaches to scale-up of integrated delivery of care is clear. 9–12 Studies assessing systems considerations for HIV-service integration show the need for collaboration and coordination between teams, staff and patients, 12–14 and the need to invest in the health workforce, particularly to support agency of decision-making, team working and load sharing.…”