Linking sexual and reproductive health and HIV in countries of Eastern Europe and Central Asia: Examining the future of integrated services
Representatives from 13 countries in Eastern Europe and Central Asia met in Antalya, Turkey, on 2–4 November to examine how to develop better linkages between Sexual Reproductive Health, HIV, sexually transmitted infections (STIs) and other services. This technical consultation brought together state ministries, non-government organizations, civil society representatives – including people living with HIV, technical experts and development partners. The meeting focused on the distinct lack of sexual and reproductive health (SRH) including family planning (FP) services in the region for HIV-positive people and key populations at higher risk of HIV exposure. Universal access to SRH services is one of the Millennium Development Goals. In times of economic constraint, countries also need to maximize efficiency of health services, by moving towards more integrated services.
The joint meeting was hosted by UNICEF, WHO/Europe and UNFPA Eastern Europe and Central Asia Regional Office, in Antalya, Turkey. The meeting provided an opportunity to consider current best practices in linked SRH and HIV services, plans including the European Action Plan for HIV/AIDS 2012–2015, identifying opportunities for better linking of services and planning next steps for how to implement them. Key aspects of linked services were considered at governance, financing, resources and service delivery levels, include comprehensive prevention of mother-to-child transmission of HIV, management of STIs, and condom programming for dual protection to prevent HIV transmission and unplanned pregnancies. In addition, access to the full range of contraceptive choices for people living with HIV and key populations is crucial for rights-based programming.
In terms of increasing uptake of family planning services by HIV-positive people and key populations, recommendations from the meeting included:
- further sensitizing health care workers on the family planning needs and rights of women living with HIV and key populations;
- creating enabling environments e.g. addressing discriminatory policies and punitive regulations;
- raising youth awareness of FP choices and sexual and reproductive rights;
- improving understanding within communities of the need for universal access to SRH services;
- increased dialogue between governmental institutions and NGOs on SRH including FP services and how to better compliment existing services.
For increasing access to FP services there are opportunities for:
- improved availability of contraceptives at the primary care level;
- working with governments to ensure contraceptives are affordable for all and to identify sources for sustainable financing;
- developing an enabling environment for non-governmental providers to offer FP services;
- widely disseminate information on the availability of services.
Quality of SRH services is improved by:
- introduction of best practice guidelines/protocols and care standards;
- continuous professional development of health care providers (revision and regular update of undergraduate and postgraduate programmes as well as in-service trainings, with development of counselling skills a priority);
- regular supportive supervision and monitoring of service quality;
- integration of FP and HIV counselling into primary care services.
Monitoring of the outcomes of linked services is also needed in terms of gauging their success. Indicators need to be aligned to existing monitoring frameworks such as the MDGs – especially target 5b “Universal Access to RH” and MDG6 “halting and reversing the spread of HIV”. Key measures are the percentage of unmet need as well as proportions of people living with HIV and key populations gaining access to contraceptives of their choice and fulfilment of their reproductive rights.
The meeting provided a space to consider the complex issues involved. With further support from UN and other development partners, there are opportunities for countries in Eastern Europe and Central Asia to improve both quality and access to comprehensive services. Changing community attitudes is also crucial to create more supportive environments where people living with HIV are more able to seek the care they need and exercise their reproductive rights and choices. Significant challenges still remain, but by utilizing participatory, inclusive and consensus building approaches, more fully integrated SRH and HIV services can be achieved.