As a gender and HIV activist, getting the opportunity to attend the 26th UNAIDS Programme Coordinating Board (PCB) meeting in Geneva, Switzerland, as a female youth observer was very important for me.Coming from Zimbabwe where HIV infection leans more towards women than men, I am always aware of the need for women and girls empowerment against oppressive gender norms if my nation is to ever overcome the epidemic which still stands towering above us at over 14% prevalence.
Prior to the two-day PCB meeting, and as part of the programme, I attended a thematic session on integrating sexual and reproductive health (SRH) and HIV services.
Quite honestly, I had never really thought of the intricacies of linking Sexual Reproductive Health (SRH) and HIV services, although I had always known about the importance of providing HIV testing and treatment services within antenatal care for pregnant women and girls.
At the thematic session, however, I learnt just how far back we are falling on this.
As Gottfried Hirnschall of the World Health Organization (WHO) shared, HIV is currently contributing to 19.2% of global maternal deaths in the 15-44 year age group. And TB is contributing a further 6.4%.
Imagine that.
TB and HIV both manageable diseases, when early detection and treatment are available are accounting for a quarter of the deaths of all pregnant women in the world.
And with southern Africa, my region of the world, being the area most affected by HIV, that means that even more women here are dying needlessly. National HIV statistics from all over the region consistently show that HIV prevalence among pregnant women who attend antenatal clinics is usually much higher than overall national figures.
It was therefore heartening to hear about some of the good work being done in the region to begin to address the urgent need for stronger integration of services.
Dudu Simelane of the Family Life Association of Swaziland gave a perspective from her country of the successes and opportunities for integration.
Her organisation is working with various development partners to provide youth-friendly SRH and HIV services that integrate interventions such as screening for STIs and TB, HIV tests, pap smears for cervical cancer, pre-and post abortion care, male circumcision, ART and the promotion of condoms for dual protection (that is, using condoms not only to prevent contracting HIV but also to prevent unwanted pregnancies).
Whats good about such sites is that they provide a broad range of services under one roof. But perhaps even more importantly, such integration helps to reduce stigma. As a visitor to one of the Swazi sites noted, Its not like other clinics where I have to go to the ART wing. I go to the same dispensary as everyone else to get my medicine.
That sort of set-up does a world of good to fight stigma and discrimination. I have heard ghastly stories in Zimbabwe about how people who visit the opportunistic infections clinics of hospitals are set apart from other people receiving services and labeled imi vanhu veHIV (you people with HIV). Such treatment has serious influence on whether a person will continue to come to collect their medicine every month and can actually lead them to stop taking drugs completely, thereby building up drug resistances and damaging the immune system.
XHEAD Stigma kills
If you think stigma doesnt kill, think again.
As Sofia Gruskin of the Harvard School of Public Health reminded us, one of the main obstacles to integration is stigma and discrimination.
In its most extreme manifestation, stigma and discrimination has seen healthcare workers sterilising HIV positive women, after childbirth, to ensure that they do not have the option to have any more children.
Also, whats been found at the sites in Swaziland is that there has been increased male involvement through the provision of male circumcision (MC) as an entry point.
Morolake Odetoyinbo of Nigerias Positive Action for Treatment Access pointed out how culture and socialisation leads to the detachment of men from SRH issues by always teaching girls about SRH and not doing the same for boys.
But nothing is without its challenges. For such service integration to be successful, there is need for a range of competencies, including capacity building as well as the fostering of strong partnerships with national and international organisations that may be able to provide staff on secondment or funds towards integration.
And a word of warning.
Integration doesnt necessarily mean cost saving. In order to be effective, it requires a lot of investment and patience. It takes time to change perceptions and attitudes. Donors need to be aware of this and should not expect radical results within a short amount of time.
XHEAD How to
So how can all of this work in the real world?
The most important thing is for healthcare workers to stop moralising and stigmatising patients. Rigorous training and monitoring is required. Journalists and the media should be mobilised to write articles on the matter so that the general public can know when they are receiving sub-standard services. A healthcare workers role is to provide quality service and not an opinion.
Secondly, I believe that current upscale of MC in Africa provides an immense opportunity for SRH and HIV integration. Rather than set up stand alone MC sites that drain resources in terms of infrastructural development and staff recruitment, lets look at integrating them into pre-existing sites.
And lets make sure that everyone who needs to get HIV services can do so. Antenatal care coverage in Africa is still too low. In fact, some women still dont know about it. Lets take the information and the services to the people and build the capacity of community-based initiatives.
But most importantly, lets remember that sexual and reproductive health rights are human rights. No, they arent a passing fad or the latest NGO buzz. When implemented, they represent human lives saved and money well spent. – Kubatana
Post published in: Analysis