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Linking Sexual and Reproductive Health and Gender Programs and Services with Prevention of HIV/STI PAHO HQ Library Catalog-In-Publication

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Linking Sexual and Reproductive Health and Gender Programs and Services with Prevention of HIV/STI PAHO HQ Library Catalog-In-Publication Linking Sexual and Reproductive Health and Gender Programs and Services with Prevention of HIV/STI PAHO HQ Library Catalog-in-Publication Pan American Health Organization “Linking Sexual and Reproductive Health and Gender Programs and Services with Prevention of HIV/STI” Washington, D.C.: OPS, © 2010 ISBN: 978-92-75-13077-3 I. Title 1. HIV INFECTIONS – prevention & control 2. SEXUALLY TRANSMITED DISEASES – prevention & control 3. REPRODUCTIVE HEALTH SERVICES – organization & administration 4. PREVENTIVE HEALTH SERVICES – methods 5. HEALTH PROMOTION 6. SEX EDUCATION – manpower 7. SEXUALLITY NLM WC503.6 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the HIV/AIDS Unit, Pan American Health Organization, Washington, DC, USA, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2010 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The Pan American Health Organization is an international public health agency with 100 years of experience working to improve health and living standards of the people of the Americas. It enjoys international recognition as part of the United Nations system, serving as the Regional Office for the Americas of the World Health Organization, and as the health organization of the Inter-American System. Further information: http://www.paho.org Table of contents INTRODUCTION A. Sexuality and health ..................................................................................................................................... 1 B. Linkage, articulation, or integration? ........................................................................................................ 3 1. BACKGROUND AND JUSTIFICATION A. Importance of harmonizing efforts in sexual and reproductive health, the gender perspective, and programmmatic responses to HIV/AIDS and other sexually transmitted infections ............. 7 B. Progress in and impediments to linking sexual and reproductive health interventions, the gender perspective, and program responses to HIV/AIDS and other sexually transmitted infections ........................................................................................................................................................ 7 2. RATIONALE FOR LINKING SEXUAL AND REPRODUCTIVE HEALTH AND GENDER PROGRAMS AND SERVICES WITH HIV/STI PREVENTION A. Integrating sexual and reproductive health ............................................................................................. 9 B. Sexuality and HIV prevention ..................................................................................................................... 10 C. Human Rights-based approach ............................................................................................................... 11 D. Creating a culture of prevention ............................................................................................................... 12 3. SOCIAL DETERMINANTS OF HIV/AIDS AND THE KEY ROLE OF SEXUALITY ................... 17 4. GOALS, STRATEGIES, AND SETTINGS FOR ADDRESSING SEXUAL AND REPRODUCTIVE HEALTH THROUGHOUT THE LIFE CYCLE A. First year of life .............................................................................................................................................. 21 B. Infancy (1–5 years) ..................................................................................................................................... 23 C. Childhood (5–9 years) ................................................................................................................................ 24 D. Adolescence .................................................................................................................................................. 28 D.1 Early adolescence (10–14 years) .................................................................................................... 29 D.2 Late adolescence (15–19 years) ..................................................................................................... 30 E. Early and middle adulthood (20–49 years) ............................................................................................ 31 F. Maturity and old age (50 years and over) ............................................................................................... 33 5. STAGES IN THE DEVELOPMENT OF STRATEGIES FOR LINKING SEXUAL AND REPRODUCTIVE HEALTH PROGRAMS AND SERVICES WITH COMPREHENSIVE HIV/STI PREVENTION AND CARE A. Situational analysis ....................................................................................................................................... 35 B. Data collection and analysis ...................................................................................................................... 38 C. Advocacy for the agenda ............................................................................................................................ 39 D. Promotion of training ................................................................................................................................... 39 Linking Sexual and Reproductive Health and Gender Programs and Services with Prevention of HIV/STI E. Intervention design ....................................................................................................................................... 40 F. Preparation of a plan of action .................................................................................................................. 41 G. Monitoring and evaluation .......................................................................................................................... 41 H. Dissemination of lessons learned, information, and data .................................................................... 43 6. ARCHITECTURE OF INTEGRATED SERVICES ................................................................................ 44 Sample algorithms for delivery of basic packages of services ................................................................. 49 7. ANNEXES Annex 1 Milestones in the harmonization of efforts in sexual and reproductive health, the gender perspective, and programmatic responses to HIV/AIDS and other sexually transmitted infections 55 Annex 2 Experiences reflecting major efforts to integrate sexual and reproductive health services with HIV/STI prevention activities .................................................................................................................... 57 8. BIBLIOGRAPHY ......................................................................................................................................... 60 This document, targeted at health sector decision makers and sexual and repro- ductive health (SRH) and HIV/STI program and service managers, is the fruit of a series of intensive expert consultations organized by PAHO over the course of several months, with the participation of other United Nations agencies. his process has been geared to developing a (UNICEF); Esther Corona (World Association for Sex- work approach that not only increases the cover- ual Health [WAS]); Barbara De Zalduondo (UNAIDS); Tage of these programs and services but makes Jane Galvão (IPPF); Wolfgang Munar (Inter-American them more accessible to the segments of the popula- Development Bank); and Carlos Cáceres and Marisela tion that need them the most. At the same time, great- Padrón, who attended as expert consultants in sexual er use of these programs and services should result and reproductive health. in a substantial reduction in problems associated with sexual activity and reproduction. An additional meeting was held in Washington, D.C., in April 2008 to review the architecture of inte- HIV and other sexually transmitted infections are grated programs and services. During that meeting, so important that the actions necessary to deal with them cannot be postponed. It is therefore essential to the working document was thoroughly reviewed and integrate them into the work of SRH programs and additional recommendations were made. services. The gender dimension, which intersects with The participants at that meeting were Christopher all facets of human life, is especially visible in the area Bates, Tom Broker, Carlos Cáceres, Xóchitl Castañeda, of sexuality and reproduction. Thus, it has been regard- Arachu Castro, Barbara Clarke, Eli Coleman, Lynn Col- ed from the outset as an underlying aspect of the link- lins, Esther
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