Responding to the sexual and reproductive health needs

Responding to the sexual and reproductive health needs of PLHIV: Where are we? Jane Cottingham Presented by Claudia Garcia-Moreno Department of Reproductive Health and Research World Health Organization XVII International Aids Conference 08_XXX_MM 1 Mexico, 7 August, 2008

Historical note ● 1990 s - prevention: "safer sex" Ø Behaviour change, condoms, fidelity, abstinence… ● Early 2000 s – treatment: "3 by 5" Ø Little or no focus on sexual and reproductive health ● Prevention of mother-to-child-transmission of HIV (PMTCT) 08_XXX_MM 2 Ø Little or no attention to the sexual and reproductive health needs of HIV positive women, and none for men

Initiatives by WHO, UNFPA and other partners Guidelines on care, treatment and support for women living with HIV/AIDS and their children in resourceconstrained settings. 2006 08_XXX_MM 3 Includes: sexual health, family planning, antenatal, intrapartum, postpartum & newborn care, abortion, STIs/ RTIs and cervical cancer, for women who are and are not receiving antiretroviral therapy

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV Review of what we knew (in 2005 -2006) Published as a special issue of Reproductive Health Matters. 2007 08_XXX_MM 4 Widely distributed to all partners' networks.

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV International consultation, Addis Ababa, March 2006. co-sponsored by Engender. Health, UNFPA and WHO in partnership with GNP+, ICW, IPPF, UNAIDS Identify key issues related to policies and programmes that support the sexual and reproductive health and rights of PLHIV. Recommendations: Ø the PLHIV networks should convene a global consultation on the SRHR of people living with HIV; 08_XXX_MM 5 Ø the guidance document should cover advocacy, health systems and legal and policy issues, and be led by PLHIV with support from the UN and other agencies

Elaborating guidance to promote and protect reproductive rights of PLHIV Global consultation on sexual and reproductive health and rights of people living with HIV/AIDS. Amsterdam, December 2007. Organized by and Young Positives, supported by Engender. Health, UNFPA, WHO and UNAIDS Report and recommendations 08_XXX_MM 6 Draft guidance package: Advancing the sexual and reproductive health and rights of people living with HIV

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV SRH is essential to meeting the MDGs Increasing attention to the benefits of better integrating HIV and SRH information and services Wider availability of ARV therapy means people are living longer, healthier lives with HIV The protection of the sexual and reproductive health and rights of PLHIV is a collective responsibility Specific needs: Ø Diagnosis, management and treatment of HIV and other SIT Ø Sex education and information Ø Psychosocial support to cope with living with HIV 08_XXX_MM 7 Ø Family planning; abortion; assisted conception Ø Antenatal, delivery and postnatal services

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV testing and counselling Family planning and dual protection Abortion (in circumstances where it is not against the law) and post-abortion care Conception, pregnancy and childbirth Regular sexual health reviews (including STI screening and treatment) as an integral component of routine HIV care Screening for violence, and referrals Sexual dysfunction 08_XXX_MM 8 HPV screening; cervical cancer diagnosis and treatment Positive prevention

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV Challenges Ø Health care worker training, particularly in knowledge of laws, of new clinical practices and of ways to reduce and eliminate stigma and discrimination Ø Recognizing and maximizing the contribution of PLHIV for counselling, health worker training etc. Ø Use of the informal sector Ø Need for commonly-agreed indicators to monitor the 08_XXX_MM 9 SRH care for PLHIV (the standard indicators disaggregated by serostatus? )

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV Legal and policy considerations Ø Enacting, implementing and enforcing laws that prohibit discrimination against PLHIV Ø Relying on criminal law to prevent HIV transmission is counterproductive Ø Policies to ensure that HIV testing is voluntary and confidential, includes pre- and post-test counselling, access to treatment, care and support Ø Ensure women living with HIV retain the right to make 08_XXX_MM 10 their own informed decisions about contraceptive use

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV Legal and policy considerations Ø Forced sterilization or abortion should be specifically outlawed Ø No restrictions on the right to marry or have children Ø HIV status is irrelevant to child custody decisions Ø Ensure women retain ownership and control over economic assets 08_XXX_MM 11 Ø Governments and international agencies should set and monitor concrete targets for the participation of PLHIV in choice, design, implementation, monitoring and evaluation of SRH-related policies

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV Legal and policy considerations Ø Young people Ø Sex workers Ø Drug users Ø Men who have sex with men Ø Transgenders Ø Prisoners and people in institutional settings Ø Migrants 08_XXX_MM 12 Ø Refugees and internally displaced people

Elaborating guidance to promote and protect sexual and reproductive health and rights of PLHIV Challenges to effective implementation and advocacy Ø Stigma and discrimination Ø Gender inequality and violence Ø Social marginalisation Ø Poverty Ø Lack of collaboration Opportunities Ø Unique expertise of people living with HIV 08_XXX_MM 13 Ø Networks and alliances Ø Policy-relevant evidence

Where are we? A long way to go Partnership between UN agencies and networks of people living with HIV is ground-breaking Emerging data on integration of services, also of policies 08_XXX_MM 14 New attention by the Global Fund on the importance of SRH for addressing HIV, and achieving the MDGs