HIV/AIDS and Sexual and Reproductive Health Integration: Quarterly Highlights Newsletter (October 2009)
Contents
New addition to the integration staff
The Knowledge for Health (K4Health) Project, based at the Center for Communication Programs, is pleased to announce a new staff member, Cassandra Mickish, who will be maintaining and updating the Integration website, as well as the Family Planning and HIV/AIDS Integration Community of Practice on the IBP Knowledge Gateway (http://www.ibpinitiative.org/knowledge_gateway.php). Stay tuned to postings about the lessons from the USAID Global Health Mini-University on integration!
Male Circumcision
Male circumcision remains a hot topic of debate. We have included several recent articles on this topic below. Research highlights include:
- Male circumcision reduces men's risk of contracting HIV through heterosexual sex by roughly 50-60% (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007).
- Male circumcision does not, however, protect women if their male partners are HIV-positive (Wawer et al., 2009).
- Male circumcision can reduce the risk of contracting herpes simplex virus type 2 (HSV-2), the virus that causes genital herpes, and human papillomavirus (HPV), which can cause cancer and genital warts (Aaron et al., 2009).
Evidence for Integration
Sexual and reproductive health and HIV linkages: Evidence review and recommendations
Authors: World Health Organization [WHO]; United Nations Population Fund [UNFPA]; International Planned Parenthood Federation [IPPF]; Joint United Nations Programme on HIV/AIDS [UNAIDS]; University of California, San Francisco; Global Health Sciences.
Source: Geneva, Switzerland, WHO, 2009 Apr. [8] p.
The importance of linking sexual and reproductive health (SRH) and HIV is widely recognized. The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to SRH and HIV prevention, treatment and care and support. In order to gain a clearer understanding of the effectiveness, optimal circumstances, and best practices for strengthening SRH and HIV linkages, a systematic review of the literature was conducted. The findings corroborate the many benefits gained from linking SRH and HIV policies, systems and services.
Authors: Anand A; Shiraishi RW; Bunnell RE; Jacobs K; Solehdin N; Abdul-Quader AS; Marum LH; Muttunga JN; Kamoto K; Aberle-Grasse JM; Diaz T.
Source: AIDS, 2009, 23: 1565-1573.
Researchers found that in 2003-2005, a majority of PLWHAs in Kenya and Malawi were unaware of their HIV status and were sexually active, especially those who were married or cohabiting. Few reported using a condom at last intercourse. Of HIV-infected women not wanting more children, few used contraception. Researchers recommended that HIV testing should be expanded, and prevention programs should target married or cohabiting couples. After determining a significant unmet need for family planning among PLWHA, researchers also recommended integrating family planning services with HIV services.
Author: Cooper D; Moodley J; Zweigenthal V; Bekker LG; Shah I; Myer L.
Source: AIDS, and Behavior 2009, 13: S38-S46.
Tailoring sexual and reproductive health services to meet the needs of people living with HIV is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 individual women and men living with HIV in Cape Town, South Africa. Roughly half of men and women living with HIV were open to the possibility of having children. Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproductive health counseling and services that account for the diverse reproductive needs of these populations.
Evaluation of Integration Programs
Authors: World Health Organization [WHO]; Joint United Nations Programme on HIV/AIDS [UNAIDS]; United Nation's Children's Fund [UNICEF].
Source: Geneva, Switzerland, WHO, 2009.
With 33 million people living with HIV and 2.7 million new infections in 2007, the HIV epidemic continues to be a major challenge for global health. Although political and financial commitments and country efforts have resulted in increasing access to HIV services in recent years, the annual number of new infections remains high and continues to outpace the annual increase in the number of people receiving treatment. This report provides a global update on progress in scaling up priority health sector interventions for HIV prevention, treatment and care in 2008 towards the internationally endorsed goal of universal access.
Extending prevention of mother-to-child transmission through postpartum family planning in Lesotho
Authors: Warren C; Phafoli S; Majara B; Tsukulu T.
Source: Maseru, Lesotho, Population Council, Frontiers in Reproductive Health, 2008 Sep. [46] p.
The Lesotho Ministry of Health and Social Welfare (MOHSW), with technical support from the Frontiers in Reproductive Health Program (FRONTIERS) of Population Council and funding from PEPFAR/RHAP/USAID, carried out an operations research project to strengthen the existing postpartum care services. This study has a specific focus on strengthening linkages with existing PMTCT follow up services and family planning services during the postpartum period by changing the number, timing and content of postpartum consultations that a woman and her newborn should receive. Researchers found that facilities were prepared or needed minimal adjustments to provide the PNC services; provider knowledge improved; provider practice improved; there was an increase in women testing for HIV; there was an increase in the proportion of providers who would recommend LAM and condoms to postpartum women at 48 hours, two weeks and 6 weeks; the majority of women said they intended to use FP between 6 weeks and 6 months.
Repositioning postnatal care in a high HIV environment: Swaziland
Author: Warren C; Shongwe R; Waligo A; Mahdi M; Mazia G.
Source: Washington, D.C., Population Council, Horizons, 2008 Feb. [59] p.
Recognizing the need to improve the care and follow up of mothers and infants in the postnatal period, the Swaziland Ministry of Health and Social Welfare (MOHSW), with support from Horizons Program of Population Council, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Basics Support for Institutionalising Child Survival (BASICS), and the Central Statistics Office (CSO), carried out an operations research project to reposition postnatal care (PNC) within the context of a high HIV environment. The study confirms that the introduction of an improved postnatal package with revised timing and content provides key components of maternal, newborn, and HIV care, and increases the utilization of services among postpartum women and their infants.
Kenya integration: Integrating services for FP and HIV improves quality and HIV testing
Author: Population Council; Frontiers in Reproductive Health.
Source: Washington, D.C., Population Council, Frontiers in Reproductive Health, 2008 Jul. [2] p.
Two models of integrating counseling and testing for HIV into family planning services were feasible and acceptable to Kenyan clients and providers. Both models resulted in significant improvements in quality of care and in HIV prevention behaviors at an affordable cost. The integration strategy, including the two models, is being scaled up nationwide.
Private provider networks in Ethiopia
Author: Barnes J; Cuellar C; Melkamu Y.
Source: Bethesda, Maryland, Abt Associates, Private Sector Partnrships-One [PSP-One], 2008 Jul. [45] p.
In response to the United States Agency for International Development's (USAID) Ethiopia mission request, the Private Sector Partnerships-One (PSP-One) project fielded an assessment team to document the state of operations for the Biruh Tesfa network, identify strategies to improve network sustainability, and determine local organizations that could have a role in network management and support. In addition the team was asked to explore opportunities to integrate HIV services into the Biruh Tesfa network.
Authors: Wawer MJ; Makumbi F; Kigozi G; Serwadda D; Watya S; Nalugoda F; (...) Gray RH.
Source: The Lancet, 2009, 374(9685): 229-237.
Researchers assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners. 922 uncircumcised, HIV-infected, asymptomatic men were enrolled in this unblinded, randomised controlled trial in Rakai District, Uganda. Men were randomly assigned to receive immediate circumcision or circumcision delayed for 24 months. HIV-uninfected female partners of the randomised men were concurrently enrolled and followed up at 6, 12, and 24 months, to assess HIV acquisition by male treatment assignment. Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.
Male circumcision for the prevention of HSV-2 and HPV infections and syphilis
Authors: Tobian AAR; Serwadda D; Quinn TC; Kigozi G; Gravitt PE; Laeyendecker O; (...) Gray RH.
Source: The New England Journal of Medicine, 2009, 360: 1298-1309.
Male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure.
Guides for integration
Strategy for the integration of family planning and HIV voluntary counselling and testing services
Author: Task Force on Family Planning - VCT Integration.
Source: Nairobi, Kenya, Ministry of Health, 2007 Aug [32] p.
In Kenya, family planning services and HIV voluntary counseling and testing (VCT) have traditionally been offered separately. However, health policy-makers have begun to recognize the opportunities missed and efficiencies lost in this parallel approach. The Kenya Ministry of Health convened a group of VCT and family planning experts from other government agencies and nongovernmental organizations, with Family Health International facilitating. The group developed a national strategy to implement integrated VCT and family planning services for women, men, youth, and couples.
Author: African Union Conference of Ministers of Health Special Session (2006: Maputo) Health and Rights, 2007-2010.
Source: Addis Ababa, Ethiopia, African Union, 2006. [25] p. Special Session of the African Union Conference of Ministers of Health, Maputo, Mozambique, 18-22 Sep 2006.
This Maputo Plan of Action for the Operationalisation of the Sexual and Reproductive Health and Rights Continental Policy Framework seeks to take the continent forward towards the goal of universal access to comprehensive sexual and reproductive health services in Africa by 2015. It is a short term plan for the period up to 2010 built on nine action areas: integration of sexual and reproductive health (SRH) services into PHC, repositioning family planning, developing and promoting youth-friendly services, unsafe abortion, quality safe motherhood, resource mobilization, commodity security and monitoring and evaluation. The Plan is premised on SRH in its fullest context as defined at ICPD/PoA 1994 taking into account the life cycle approach. These elements of SRHR includes Adolescent Sexual and Reproductive Health (ASRH); Safe Motherhood and newborn care; Abortion Care; Family planning; Prevention and Management of Sexually Transmitted Infections including HIV / AIDS; Prevention and Management of Infertility; Prevention and Management of Cancers of the Reproductive System; Addressing mid-life concerns of men and women; Health and Development; the Reduction of Gender-based Violence; Interpersonal Communication and Counselling; and Health education.
Authors: Hardee K; Gay J; Dunn-Georgiou E.
Source: Population Action International: Mobilizing for RH/HIV Integration Initiative, Sep 2009.
Grounded in the research, programmatic and policy literature on linkages and integration, as well as successful country proposals that include integration, this document seeks to answer four main questions: 1) What is integration? 2) Given a country’s context, what policies and programs could be linked and integrated? 3) What are the implementation challenges to integration to be aware of when writing a proposal? 4) How can integration be monitored and evaluated? The document also provides the evidence that integration with RH can make a difference to HIV/ AIDS outcomes. This evidence is critical given the Global Fund’s requirement that funding for integrated programs is contingent on their impact on HIV prevention, care and treatment outcomes. This document provides references and links to many other resources available on various aspects of linkages and integration. It also provides examples from country programs and the integration components of successful Round 8 proposals.
Authors: World Health Organization [WHO]; United States Agency for International Development [USAID]; Family Health International [FHI]
Source: Geneva, Switzerland, WHO, 2009.
This document is designed to help program planners, implementers, and managers—including government officials and other country-level stakeholders—make appropriate decisions about whether to pursue the integration of FP and HIV services. It also explains how to pursue integration in a strategic and systematic manner, in order to achieve maximum public health benefit
News and Policy Updates
Global Fund in Rwanda agrees to finance contraceptives: Policy update
Author: John Snow [JSI]. DELIVER.
Source: Arlington, Virginia, John Snow [JSI], DELIVER, [2008]. [2] p.
In Rwanda, integration of family planning and HIV services is a national priority. In a significant step for both contraceptive security and HIV prevention in Rwanda, local Global Fund stakeholders have decided to fund contraceptives by providing a three-year commitment worth more than US$2.4 million from Round 7 Funds. Global Fund financing has been used in the past to finance condoms in a number of countries, but Rwanda is believed to be the first country to fund contraceptives as part of its efforts to fight HIV and AIDS.
U.N. cites global rise in detection and treatment of AIDS, Sep 30, 2009
Author: Dugger CW.
Source: New York Times.
URL: http://www.nytimes.com/2009/10/01/world/01aids.html?scp=8&sq=HIV&st=cse
For first time, AIDS vaccine shows some success, Sep 29, 2009
Author: McNeil Jr. DG.
Source: New York Times.
URL: http://www.nytimes.com/2009/09/25/health/research/25aids.html?_r=1&scp=8&sq=HIV&st=cse
Events
This section lists upcoming public health conferences, meetings, or other events that include activities and information concerning HIV/AIDS and Sexual and Reproductive Health Integration. If you know of an upcoming event that may be of interest to HIV/SRH Integration professionals, please e-mail info@hivandsrh.org.
International Association for Adolescent Health (IAAH) 9th World Congress, Kuala Lumpur, Malaysia. October 28-30, 2009
United States Conference on AIDS (USCA), San Francisco, CA. October 29-31, 2009
11th International Union Against Sexually Transmitted Infections World Congress, Africa 2009, Cape Town, South Africa. November 9-12, 2009
International Association of Physicians in AIDS Care (IAPAC) 2009 Conference, New Orleans, LA. November 29-December 1, 2009
5th SAHARA Conference on the Social Aspects of HIV and AIDS, Midrand, Gauteng province, South Africa. November 30-December 3, 2009
Subscription Information
Quarterly Highlights is a free electronic newsletter, distributed by e-mail four times a year, and archived on http://www.hivandsrh.org.
Interested in submitting resources to the HIV/SRH Integration Web site or sharing a story with us about your country or organization's experience with integrating programs? Please send e-mail to: info@hivandsrh.org.
HIV/AIDS and Sexual and Reproductive Health Integration: Quarterly Highlights is published by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs. It is made possible through funding from the David and Lucile Packard Foundation and the William and Flora Hewlett Foundation.