HIV/SRHR Integration for Key Populations A review of experiences and lessons learned in India and globally India HIV/AIDS Alliance India HIV/AIDS Alliance (Alliance India) is a diverse partnership that brings together committed organisations and communities to support sustained responses to HIV in India. Complementing the Indian national programme, we work through capacity building, knowledge sharing, technical support and advocacy. Through our network of partners, we support the delivery of effective, innovative, community- based HIV programmes to key populations affected by the epidemic. Our Vision: A world in which people do not die of AIDS Our Mission: To support community action to prevent HIV infection, meet the challenges of AIDS and build healthier communities
Acknowledgements Thanks are given to the many people and organisations that contributed their experiences and documentation to this publication. This report was written by Sarah Middleton-Lee (independent consultant). Alliance India would like to acknowledge the following for their contributions to this report: Sunita Grote, James Robertson, Sonal Mehta, Sophia Lonappan, Divya Bajpai and Susie McLean. This report was produced with support from the European Union.
Published in June 2012 © India HIV/AIDS Alliance Photography: Unless otherwise stated, the appearance of individuals in this publication gives no indication of their HIV or key population status. Information contained in the publication may be freely reproduced, published or otherwise used for non-profit purposes without permission from India HIV/AIDS Alliance. However, India HIV/AIDS Alliance requests to be cited as the source of the information. The contents of this publication are the sole responsibility of India HIV/AIDS Alliance and do not necessarily reflect the views of the European Commission. Recommended Citation: India HIV/AIDS Alliance (2012). HIV/SRHR integration for Key Populations: A review of experiences and lessons learned in India and globally. New Delhi: India HIV/AIDS Alliance.
This project is funded by the European Union India HIV/AIDS Alliance Kushal House, Third Floor 39 Nehru Place
New Delhi – 110019 +91-11-4163-3081 [email protected] www.allianceindia.org HIV/SRHR Integration for Key Populations
A review of experiences and lessons learned in India and globally Acronyms
ANC Antenatal care ART Antiretroviral therapy ARVs Antiretroviral drugs FHI Family Health International FP Family planning GIPA Greater involvement of people living with HIV GNP+ Global Network of People Living with HIV IPPF International Planned Parenthood Federation HCT HIV counselling and testing HPV Human papillomavirus IDU Injecting drug user KPs Key populations MNCH Maternal, newborn and child health MSM Men who have sex with men OSI Open Society Institute OST Opiate Substitution Therapy PEP Post-exposure prophylaxis PMTCT Prevention of mother to child transmission PNC Postnatal care PUD People who use drugs RTI Reproductive tract infection SRHR Sexual and reproductive health and rights STI Sexually transmitted infection SW Sex worker UNAIDS United Nations Joint Programme on AIDS WHO World Health Organisation Contents
1. Introduction 1
1.1. Content of report ...... 1
1.2. Rationale and context for review ...... 1
1.3. Objectives and methods of review ...... 2
2. Overview of HIV/SRHR integration for key populations 3
2.1. What are the SRHR needs of key populations and why do they matter? ...... 3
2.2. What is HIV/SRHR integration? ...... 5
2.3. Why is HIV/SRHR integration a vital strategy for key populations? ...... 7
2.4. What strategies are being used for HIV/SRHR integration for key populations? .... 8 2.5. What lessons have been learned about HIV/SRHR integration for
key populations? ...... 10 1. Promote good practice principles throughout HIV/SRHR integration for
key populations: ...... 10 2. Plan and get started on HIV/SRHR integration by building on ‘what’s there’,
gathering evidence and identifying key entry points: ...... 10 3. Ensure comprehensive HIV/SRHR integrated programming for
key populations: ...... 11 4. Ensure effective and creative service delivery for HIV/SRHR integration for
key populations: ...... 12 5. Ensure a strong ‘chain’ of HIV/SRHR integrated services for key populations,
including through high quality and systematic referrals: ...... 13 6. Promote HIV/SRHR integration for key populations at all levels, including
building an enabling internal and external environment: ...... 13 7. Address the political, legislative and funding context of HIV/SRHR
integration for key populations: ...... 13 2.6. How do organisations ‘get started’ with HIV/SRHR integration for
key populations? ...... 14
3. HIV/SRHR integration for people living with HIV 17
3.1. What does HIV/SRHR integration for people living with HIV involve? ...... 17 3.2. What are some common strategies for HIV/SRHR integration for people
living with HIV? ...... 18 3.3. What lessons have been learned about good practice HIV/SRHR integration
for people living with HIV? ...... 18
3.4. Case studies of HIV/SRHR integration for people living with HIV ...... 20 4. HIV/SRHR integration for sex workers 31
4.1. What does HIV/SRHR integration for sex workers involve? ...... 31
4.2. What are some common strategies for HIV/SRHR integration for sex workers? ...32 4.3. What lessons have been learned about good practice HIV/SRHR integration
for sex workers? ...... 32
4.4. Case studies of HIV/SRHR integration for sex workers...... 34
5. HIV/SRHR integration for men who have sex with men 47 5.1. What does HIV/SRHR integration for men who have sex with men (MSM) and
transgender people involve? ...... 47 5.2. What are some common strategies for HIV/SRHR integration for men who
have sex with men and transgender people? ...... 48 5.3. What lessons have been learned about HIV/SRHR integration for men who
have sex with men and transgender people? ...... 49 5.4. Case studies of HIV/SRHR integration for men who have sex with men and
transgender people ...... 51
6. HIV/SRHR integration for people who use drugs 61
6.1. What does HIV/SRHR integration for people who use drugs involve? ...... 61 6.2. What are some common strategies for HIV/SRHR integration for people
who use drugs? ...... 62 6.3. What lessons have been learned about HIV/SRHR integration for people
who use drugs? ...... 62
6.4. Case studies of HIV/SRHR integration for people who use drugs ...... 64
7. Conclusions and key messages 73
HIV/SRHR Integration for KPs: Key Messages ...... 75
Annex 1: List of resources for review 77
Sources of information for review ...... 77
India: ...... 77
Global:...... 77
India resources included in review ...... 78
Resources related to HIV/SRHR integration for key populations (general) ...... 78
Resources related to HIV/SRHR integration for specific key populations ...... 79
Global resources included in review ...... 81
Resources related HIV/SRHR integration for key populations (general) ...... 81
Resources related to HIV/SRHR integration for people living with HIV ...... 83
Resources related to HIV/SRHR integration for sex workers ...... 84 Resources related to HIV/SRHR integration for men who have sex with
men and transgender people ...... 85
Resources related to HIV/SRHR integration people who use drugs...... 86 Annex 2: Key SRHR vulnerabilities for key populations: Alliance Good Practice Guide 87
Annex 3: Gender and SRHR issues for people who use drugs: Alliance Good Practice Guide 92
Women...... 92
Lack of “women-friendly” services ...... 92
Gender and vulnerability ...... 92
Women and injecting – risks and vulnerabilities ...... 93
Women, sex work and drug use ...... 93
Pregnancy and motherhood ...... 93
Annex 4: Ten essential steps to strengthen family planning and HIV service integration (Family Health International) 94
1 © Eugenie Dolberg for the Alliance
1. Introduction
1.1. Content of report Figure 1: Who are key populations? This report summarises the findings of a review commissioned by ‘Key populations’ refers to groups that are India HIV/AIDS Alliance of experiences and lessons from integrating particularly vulnerable to and affected by HIV and sexual and reproductive health and rights (SRHR) in HIV. They are key to both the dynamics of programmes for key populations [see Figure 1]. and response to epidemics. The report outlines definitions and benefits of HIV/SRHR integration Reflecting Alliance priorities, this review for key populations and presents some general lessons learned focused on five such groups: about good practice. It then addresses each of the selected key People living with HIV populations – describing issues to consider within integrated HIV/ Sex workers SRHR support, sharing key strategies and providing examples of Men who have sex with men integration in action. Transgender people People who use drugs
1.2. Rationale and context for review The review was carried out within a context of growing interest in HIV/SRHR integration [as defined in Section 2]. There is a growing wealth of evidence that the strategy ‘makes good sense’ and brings concrete benefits – including to people, services and national health systems. The review specifically responded to the ‘push’ for HIV/SRHR integration within the changing and increasingly complex environment for responses to HIV. Within this context – one characterised by constrained resources, increased demands for cost-efficiency and political re-positioning (with HIV increasingly integrated into wider frameworks for health) – integration is clearly an important strategic option. It also, however, risks being seen as a ‘magic bullet’. In India – as well as other countries in the Asia and the Pacific Region and globally – there is increasing policy support for the concept of HIV/SRHR integration. However, there remain significant questions and uncertainties about what such programming means in practice. This is particularly the case within the context of a concentrated HIV epidemic – where little is still known about what integration should ‘look like’ (for groups such as sex workers and men who have sex with men) and what practical opportunities and challenges it involves. HIV/SRHR integration for key populations 2 The objectivesofthereviewwere: needs ofkeypopulations. integration, thisstrategycannotonlyimprovetheefficiencyofprogrammesbuttrulyserve This reviewaimstoassesshow,withinthecontextofgreaterpoliticalsupportforSRHR/HIV 1.3. Objectivesandmethodsofreview contexts? Andwhatispossibleintheshort-termandgoalsshouldbesetforlong-term? example, whattype,paceandscaleofintegrationworksbestforspecificpopulationsin forkeypopulations?For ensure thatintegrationdoesnotcompromiseaccesstoservices outcomes specificallyforkeypopulations?Ifso,whatneedstobetakenintoaccount to supportHIV/SRHRintegrationasaneffectiveapproachimprove A numberofcriticalquestionsremainoutstanding.Theseinclude: compromise outcomesforkeypopulations. interventions, integratingservicesandsystemsthatarenotreadymayintheshort-runactually While thisapproachclearlyhasthepotentialtoincreasereachandimprovequalityof into accountwhennationalresponsesaimtoscaleupSRHR/HIVintegratedprogramming. recommendations forSRHR/HIVintegratedprogrammes.Thesechallengesneedtobetaken access toservicesforkeypopulations.Thisreviewidentifiesanumberofchallengesand of programmesandsystemsthatarenotreadycould,infact, However, whileintegrationisadesirablegoalinthelong-run,concernsremainthatjoining different contextsandmodels the HIV/SRHRcomponentsintegrated,lessonslearned, etc.)tofacilitatecomparisonacross a templatewasusedtorecordthedetailsofprogrammes (suchasthetypeofpopulation, mappings, toolkits,policybriefingsandreports.Where adequateinformationwasavailable, agencies andUN[see websites ofselectednationalandinternationalorganisations, includingNGOs,technicalsupport The methodologyforthereviewfocusedonassessing over 160resourcesavailableonthe groups. populations ordetailed,technicalguidanceonthe‘howto’ofintegratedprogrammingforsuch It alsodidnotaimtoprovidecomprehensivedocumentationoftheSRHRneedskey The reviewdidnotaimtoserveasasystematicormeta-analysisofallrelevantdocumentation. 3. 2. 1.
contexts ofkeypopulations. such programmesarebasedongoodpracticeandrespondtothespecificneeds integrated programmesbyIndiaHIV/AIDSAlliance To informthefuturedevelopment,implementationandevaluationof overall andinrelationtothefiveprioritygroupsforIndiaHIV/AIDSAlliance. lessons learned From thatdocumentation,to HIV/SRHR integrationforkeypopulationsinIndiaandinternationally. To identifyandreviewa from HIV/SRHRintegratedprogrammingforkeypopulations–both Annex 1 selection ofexistingdocumentation identify andanalysesuccessfulapproaches for alist].Theresourcesincludedcasestudies, compromise – inparticularensuringthat Do wehavestrongevidence both onprogrammingfor SRHRandHIV the qualityofand HIV/SRHR 3
2. Overview of HIV/ © Prashant Panjiar for India HIV/AIDS Alliance SRHR integration for key populations
2.1. What are the SRHR needs of key populations and why do they matter? According to universal commitments, key populations have the same, universal sexual and reproductive rights as anyone else. For example, they have the right to have sexual relations free from coercion, to have children and to protect themselves from infection. Key populations also share many common needs for HIV and SRHR information, support, services and commodities. For example, like other community members, they might require access to HIV testing, advice about family planning and access to maternal, newborn and child health (MNCH) services. In practice, however, there are a significant number and range of factors that mean that key populations often experience both heightened vulnerability to SRH ill health (such as STIs, unintended pregnancies and maternal mortality) and greater barriers to the support and involvement that they need [see Figure 21 for a summary and Annexes 2 and 3 for extracts from Alliance Good Practice Guides on ‘Integration of HIV and Sexual and Reproductive health and Rights’ and ‘HIV and Drug Use: Community Responses to Injecting Drug Use and HIV’]. These factors are further affected by the context of and differences between individuals, such as in terms of sex, age and status. For example: a young woman who is living with HIV might have greater family planning needs than a woman who is older; a man who has sex with men (MSM) who is married to a woman may have more complex SRHR needs than a man who is not; a sex worker who lives in a rural area may be less able to access SRHR services than one in a city; or a woman who uses drugs who is unmarried might find it harder to access SRHR services than a woman who is married.
1 Adapted from: Integration of HIV and Sexual and Reproductive Health and Rights: Good Practice Guide, International HIV/AIDS Alliance, 2010; and Who Are We Failing? How Marginalisation and Vulnerability Affect Adolescents’ Needs for and Access to SRHR, Interact Worldwide, 2011. HIV/SRHR integration for key populations 4 SRHR services accessing barriers to or stronger Additional SRHR needs more complex Specific or Factors Figure 2: SRHR services to demand opportunities capacity or Weaker
Factors thataffectkeypopulationsinthecontextofSRHR For example,compared toothercommunitymembers… because theyare leftout of communitycapacitybuildingprojects. People whousedrugsmightlacktheskillstodefinetheir SRHRneeds making becausetheylacklegalstatus. Transgender peoplemightnotbeabletoparticipateinSRHRdecision- advocate fortheirSRHRneedstodecision-makersinhealthservices. People livingwithHIVmightlackself-esteemor‘safespaces’to projects becausetheyare a‘hiddenpopulation’. MSM mightnotbeincludedinthemonitoringandevaluationofSRHR women’s SRHR needs. Sex workersmightnotbeincludedinprovincial consultationson STIcentregovernment iftheyare criminalized. A personwhousesdrugsmightnotbeallowedtoregister ata equipment orexpertisetocarryoutano-genitalexaminations. clinicifthestaffAn MSMmightnotaccessagovernment lackthe project focusedonharmreduction. A womanwhousesdrugsmightfeelunabletodiscussSRHRneedsina they facethreats bythepolice. A transgendersexworkermightnotaccessapublicSRHRserviceif family planningclinicinnormalopeninghours. A femalesexworkermightworkatnightsandnotbeabletoaccessa mainstream antenatalservices. A womanlivingwithHIVmightfacestigmaanddiscriminationbystaff at female partnerandprevent HIVwithamalepartner. An MSMwhoismarriedmightrequire supporttoplanafamilywithhis safer sexwhileundertheinfluenceofdrugs. A manwhousesdrugsmightneedbehaviourchangesupporttoensure Antiretroviral therapy. specific adviceoninteractionsbetweenmethadone,contraceptivesand A pregnant womanwhousesdrugsandislivingwithHIVmightrequire reassignment. A transgenderpersonmightrequire specialistcounselingongender- regular accesstoSTItesting. A malesexworkermightrequire larger suppliesofcondomsandmore exposure prophylaxis. violent sex–increasing herneedforemergency contraceptionandpost- A femalesexworkermightexperiencehigherlevelsofcoerced and 5 HIV/SRHR integration for key populations How HIV/SRHR integration “Linkages and integration enable enable integration and “Linkages people, more reach to programmes more respond to populations, key especially HIV both reach to and needs their to fully Linkages effectively. more goals SRH and the address to programmes strengthen including ill-health, SRH of causes root also HIV and SRH between Linkages HIV. that issues structural and social the address ill-health SRH to vulnerable people make stigma poverty, inequality, gender – HIV and and violations rights discrimination, and legal issues.” Good Practice HIV Programming International Standards, HIV/AIDS Alliance Figure 4: strengthens programming UCSF, WHO, UNAIDS, UNFPA and IPPF, 2009; ]. , International HIV/AIDS Alliance, June 2010. This . Rapid Assessment Tool for Sexual and Reproductive Health Rapid Assessment Tool International HIV/AIDS Alliance, 2010. Figure 4 International HIV/AIDS Alliance, 2010. Figure 5 , International HIV/AIDS Alliance, June 2010. . It can, for ]. These needs often ‘fall through the net’ often ‘fall through ]. These needs 7 [see 2
and Programming 3 4 ’s access to a wider Figure 3 , as well as leaders in the field 6 Good Practice HIV Programming Standards [see in Manipur found that: individual one or more components of in Andhra Pradesh found that: , IPPF, UNFPA, UNAIDS and WHO, 2005; and Good Practice HIV Programming Standards , IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW and Young Positives, 2009. Examples of key populations’ unmet SRHR needs, India populations’ unmet SRHR needs, Examples of key female sex workers women who use drugs of the International HIV/AIDS Alliance. [See 5 A Framework for Priority Linkages Sexual and Reproductive Health and HIV Linkages: Evidence Review and Recommendations, to guide the design, implementation and evaluation of Alliance programmes in seven areas, with each including a number of agreed standards to guide the design, implementation and evaluation of Alliance programmes in seven areas, with each including a number
Good Practice Guide: Integration of HIV and Sexual and Reproductive Health and Rights, side effects. to abortion (with 10% self- Most resorted 30% had experienced unintended pregnancies. post-abortion complications. induced at home) and the majority had type of services – due to judgemental attitudes Government the least preferred clinics were and low confidentiality. Many concealed their drug use from health providers. Many concealed their drug use from used condoms with clients, few used them with their regular Although 70-75% regularly partners. form of contraception, but little information was given about the most popular Oral pills were 56% of those that were married had an unmet need for contraception. married had an unmet were 56% of those that in the last 3 months. symptom an STI-related 52% had experienced sex and 17% physical violence in last 3 months. 15% had experienced forced and India HIV/AIDS Alliance (150 women who use drugs, aged 18-49 years in 3 sites in Manipur) India HIV/AIDS Alliance. Understanding Barriers to Sexual India HIV/AIDS Alliance (150 women who use drugs, aged 18-49 years in 3 sites in Manipur) India HIV/AIDS Alliance. Understanding in Andhra Pradesh). Reproductive Health for FSW. Hyderabad, India HIV/AIDS Alliance Andhra Pradesh. (146 female sex workers in 5 districts Good Practice Guide: Integration of HIV and Sexual and Reproductive Health and Rights, Standards (measurable and evidence-based benchmarks of quality). For example: and HIV Linkages: A Generic Guide For example: India HIV/AIDS Alliance and SASO (2011). In the Shadows: The Chanura Kol baseline study on Women who inject drugs in Manipur. India. New Delhi. India HIV/AIDS Alliance and SASO (2011). In the Shadows: The Chanura Kol baseline study on Women who inject drugs Based on description of Standard 4.1 in A study of Figure 3: A study of
significant unmet needs for SRHR unmet needs for significant As a result of these multiple and often overlapping factors, key populations can experience can experience factors, key populations and often overlapping of these multiple As a result for the 11 good practice standards]. The review was also informed by key normative documents on integration produced by the International Planned Parenthood Federation (IPPF) and partner UN agencies (UNFPA, UNAIDS and WHO) 3 4 5 6 7 2 includes referrals from one service to another, with the overall includes referrals from one service aim of providing more comprehensive support 2.2. What is HIV/SRHR integration? In this review, integration refers to into (or ‘joined with’) one SRHR programming being integrated or vice versa or more components of HIV programming; There is increasing evidence and recognition that HIV/SRHR integration brings multiple benefits at multiple levels of integration in India, notably PATH India. of SRHR services (that are often designed for the general public and focus on mainstream and focus on mainstream the general public designed for services (that are often of SRHR are often designed to address people’s planning) and HIV services (that services, such as family person’). rather than looking at the ‘whole high risk behaviours, This review was based on the understanding of HIV/SRHR integration promoted by the Good Practice Guide Standards example increase and improve: an HIV/SRHR integration for key populations 6 protection from are particularlyevidentintheuptakeofkey‘cross-over’services,suchascondoms(fordual including the2011UN HIV/SRHR integrationhasbeenincreasinglyrecognizedinkeyglobalpolicycommitments– and 6(combatHIV,malariaotherdiseases). seen ascriticaltoachieving 10 9 8 resources; andahealth range of
11 10 9 8 7 6 5 4 3 2 1 International HIV/AIDSAlliance Figure 5:
PoliticalDeclarationon HIV/AIDS:IntensifyingourEffortstoEliminate HIV/AIDS SexualandReproductive HealthandHIVLinkages:EvidenceReview andRecommendations, A FrameworkforPriority Linkages, services andsupport. which undermineprotective behavioursandactasbarrierstoaccessingSRHHIV Our organisation has apolicyandprogramme toaddress stigmaanddiscrimination, address gender-based andsexualviolenceabuseinitsHIVSRHresponse. In collaborationwithothers,ourorganisation promotes and/orprovides interventionsto address genderandsexualityasanintegralcomponentoftheSRHHIVresponse. Our organisation workswithotherstopromote and/orimplementprogrammes that capacity ofserviceproviders tobettermeettheneedsofourbeneficiaries. feasible ratherthansettingupparallelservices.We collaborate withandbuildthe Our organisation promotes andrefers userstoquality, user-friendly serviceswhenever condoms. Our organisation promotes and/orprovides STIeducation,diagnosis,treatment and Our organisation promotes andincreases uptakeoftheessentialelementsPPTCT. HIV thatisintegratedwithreproductive andoptions. concerns Our organisation promotes and/orprovides information,educationandcounselingon specific andtailored topeople’s needs. increases knowledge,self-esteemandskillsissociallyculturallycontext- Our organisation promotes and/ordeliverssexualityeducationthatiscomprehensive, involved atallstagesoftheproject cycle. The peoplemostaffected byHIVandSRHproblems are meaningfullyandconsistently people. In collaborationwithothers,ourorganisation promotes theSRHneedsandrightsofall programmes andservices. Our organisation promotes thelinkingandintegrationofSRHHIVinpolicies, both Good practiceprogrammingstandardsforHIV/SRHRintegration, HIVandSRHRsupport;a both HIVandunwantedpregnancy) WHO,UNFPA,UNAIDS andIPPF,2005. Political DeclarationonHIV/AIDS system both ’s collaborativeplanningandmanagement MillenniumDevelopmentGoals5(improvematernalhealth) service ’s efficientuseofhumanandfinancial , UNGeneralAssembly, June2011. 9 . UCSF, WHO,UNAIDS, UNFPAandIPPF,2009. 10 – andnationalframeworks.Itis 8 . Thebenefits 7 HIV/SRHR integration for key populations , , 26th Meeting of the – increasing key – increasing – by enabling them to GNP+, ICW, Young Positives, – increasing key populations’ key populations’ – increasing . However, on the whole, 13 – going beyond a focus on ‘disease , for example by reducing the the , for example by reducing support
related to HIV and/or key populations HIV and SRHR
Sexual and Reproductive Health and HIV Linkages: Evidence Review and Recommendations . This is because – beyond the generic benefits to all . This is because – both 11 for , IPPF, UNFPA, UNAIDS and WHO, 2005.
. ]. 12 Potential benefits of HIV/SRHR integration for key populations Potential benefits of HIV/SRHR integration Thematic Segment: Sexual and Reproductive Health Services with HIV Interventions in Practice: Background Paper A Framework for Priority Linkages Figure 6 be ‘tailor made’ to the specific and sometimes complex needs of key populations. be ‘tailor made’ to the specific and sometimes for key populations Improves the efficiency of services work, transport costs, time off people’s appointments (reducing of health-related frequency etc.). and human resources for HIV/SRHR programmes for Makes good use of scarce financial key populations Promotes a rights-based and ‘whole person’ approach Promotes a rights-based and ‘whole someone as a ‘whole person’ who has the right to have satisfying sexual to treating control’ etc. a family, relations, Reduces stigma and discrimination issues and needs. populations’ access to services by ‘normalising’ of HIV and SRHR services Increases the quality and appropriateness Provides a ‘one stop shop’ and continuous support. access to and uptake of comprehensive EngenderHealth, IPPF and UNAIDS, 2009. Adapted from: UNAIDS Programme Coordinating Board, June 2010; and WHO, UNFPA, IPPF, UNAIDS and UCSF, 2008 A Guidance Package, Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV:
Figure 6: integrated programming. In response, an increasing number of organisations working with key populations in a variety of with key populations in a variety number of organisations working In response, an increasing practice. This involves a broad spectrum putting HIV/SRHR integration into different settings are specific components to full-scale comprehensive of approaches – from the joining of small, to reduce stigma and discrimination and increase the quality and relevance of SRHR services and relevance of SRHR services discrimination and increase the quality to reduce stigma and [see community members – integration has the potential to address some of the specific factors, address some of the specific factors, – integration has the potential to community members vulnerability. For example, it can help that heighten such groups’ SRHR needs and challenges 11 For example: 12 13 Based on these experiences, there is some emerging consensus about ‘what matters’ and Based on these experiences, there is ‘what works’, for example in HIV/SRHR integration for PLHIV populations? that the strategy particularly HIV/SRHR integration, it is often indicated Within dialogue on key populations ‘makes sense’ for 2.3. Why is HIV/SRHR integration a vital strategy for key for a vital strategy integration is HIV/SRHR 2.3. Why practice. and especially for the other populations – sex workers, people who use drugs, MSM and and especially for the other populations – sex workers, people who use drugs, good practice transgender people – there remain important questions about what constitutes the strategy into for integration, and what opportunities and challenges are involved in putting HIV/SRHR integration for key populations 8 strategies forHIV/SRHRintegrationkeypopulations: The reviewidentifiedthattherearearangeofexamplesinterestingand/orsuccessful for keypopulations? 2.4. WhatstrategiesarebeingusedforHIV/SRHRintegration Sex workers People livingwithHIV HIV programme Figure 7: (especially HCT) components or selectedHIV Comprehensive (plus widerHIV) HIV prevention services forSWs specific, key HCT orother HIV prevention Advocacy onHIV PMTCT andART) services, e.g. followed byother HCT (often for PLHIV General services and support) PMTCT orcare HCT (alsooften care andsupport) ART (alsooften HIV) HCT (andbroader
Examples ofstrategiesforHIV/SRHRintegrationkeypopulations Integration SRHR programme or gender-based related toSTIs of SRHR(e.g.support Selected components SRHR) FP (alsooftenbroad and/or broad SRHR) FP (alsooftenSTIs condoms) (especially STIsand components or selectedSRHR Comprehensive wider SRHR) STI prevention (plus condoms) (especially STIsand Broad SRHR dual protection Female condomsfor STIs andcondoms) SRHR, especially FP (andbroader Advocacy onSRHR SRHR) FP (alsooftenbroad violence) Case studiesinthisreport Alliance inUganda,Uganda HIV/AIDS International Gheskio, Haiti MAMTA, India PSI, Zimbabwe HCT Centres, Ethiopia HCT Centres, Kenya POZ, Haiti Ministry ofHealth,Kenya TASO, Uganda TOP, Myanmar Concern/HMAP, Pakistan Community Support ISH, Serbia YPSA, Bangladesh CSI, India PATH India,India Avahan programme, India CEMOPLAF, Ecuador FPAM, Malawi EC-CAP, Caribbean KANCO, Kenya Aastha Project, India SAATHII, India FHOK, Kenya Republic PROFAMILIA, Dominican ABEF, Rwanda 9 HIV/SRHR integration for key populations Humsafar Trust, India Humsafar Trust, India SAATHII, Malaysia DICP, Korsang, Cambodia OSI, Ukraine SASO, India Five Hearts Service Centre, China PKBI, Indonesia Puskesmas, Indonesia FPA India, India FPA Colombia PROFAMILIA, RHAC, Cambodia Mythi clinics (Avahan India Programme), Nadu State AIDS Tamil and APAC Society, Control India TAI, Bandhu Social Welfare Bangladesh Society, and Pakistan PAVNHA Pakistan Society, Blue Diamond Society, Nepal North Africa Regional InternationalProgramme, HIV/AIDS Alliance Espace Confiance, Cote D’Ivoire condoms and STIs and often specifically including women’s health) SRHR or Broad primary health care Advocacy on SRHR SRHR (especially SRHR, especially STIs STIs Selected components of SRHR FP (and broader FP (and broader SRHR, especially STIs)