Linking Sexual Health and HIV Programs

This Pan American Health Organization (PAHO) publication seeks to make a contribution to efforts to optimise health care, including sexual and reproductive health (SRH) promotion and care, with a gender perspective that explicitly addresses HIV and other sexually transmitted infections (STIs). "The publication stresses the importance of collaboration among programs, services, providers, and community members to better tackle the challenges posed by these issues and also proposes actions that can lead to a better quality of life for the individual, the family, and the community."

As stated here, "adolescent motherhood, the disproportionate number of new HIV infections in this population, and the high incidence of STIs among young people are indicators of unprotected sex stemming from lack of access to comprehensive sex education and high quality sexual and reproductive health promotion services....For PAHO, creating dynamic links between programs and services designed to improve the sexual and reproductive health of the most vulnerable population is an ethical imperative, a technical challenge, and a mandate from its Member States....Thus, integration of sexual health, reproductive health, gender, and prevention of HIV/AIDS and other STIs is a critical strategy for ensuring that adolescents and adults, both male and female, can enjoy healthy, satisfying, and safe sex free of violence and coercion and without inequities associated with gender or sexual orientation. The purpose of this document is to offer readers a strategic proposal developed by experts from the Region."

According to the document, "no strategy by itself can guarantee the linkage, articulation, or integration of health programs, initiatives, and services. However, a series of steps can be taken to facilitate achievement of the synergies sought." These steps include:

• Situational analysis: Verify what happens in real life - include an "exhaustive analysis of health systems’ strengths, weaknesses, and opportunities with respect to carrying out the integration."
• Data collection and analysis: Evidence is needed of best practices and examples. Factors that foster the linkage, coordination, and integration of programs and services in SRH and HIV/STI prevention include:
  • Positive attitudes and the use of best practices and examples of success by service providers and personnel - "draw a clear distinction between integration and expansion that lacks a focus."
    
  • Ongoing capacity building
    
  • Government and community participation in planning and implementation
    
  • Simplification of procedures to offer additional services without increasing the cost of existing ones
    
  • Services to which stigma is not attached
    
  • Inclusion of couples, especially male couples
    
  • Inclusion of vulnerable populations
• Advocacy for the agenda: Become an ardent supporter - "Free and informed decision making, confidentiality, respect, fair treatment, protection from abuse and discrimination, and access to the highest attainable quality of care should always be the goal, and any situation that does not guarantee these rights should be avoided."
  
• Promotion of training: Ensure that the parties involved learn and develop their competencies.
  
• Intervention design: Spell out what is going to be done, how it is going to be done, and who is in charge - "Linkage, articulation, and integration are more likely to be successful when they are buttressed by good management. It is also good managerial practice to ensure that the different local agencies and sectors are represented in any planning and implementation activity. The same types of partnerships and associations should be forged at the professional level, whenever possible reaching out to professional associations and academic societies. Community participation should always be promoted and secured, especially from the potential users of integrated services, such as women, young people, people with HIV, men who have sex with other men, sex workers, and other vulnerable populations."
  
• Preparation of a plan of action: Develop a critical path with clear milestones and specific goals, including:
  •  "Define the public awareness and training needs that will guide continuing education programs for service and program staff and other stakeholders.
    
  • Develop a communications program to ensure that people are aware of the availability of these integrated programs and that they demand and use them.”
    
• Monitoring and evaluation: Ensure that you are moving in the right direction to obtain the desired results.
  
• Dissemination of lessons learned, information, and data: Share the challenges encountered and show, insofar as is possible, why the linked, articulated, or integrated programmes and services are effective, are not effective, or how they could be effective - "It is important to document, compile, and disseminate information on experiences at all levels through reports, articles in peer-reviewed scientific journals, or other media."

The document reviews the settings in which the service are offered, the beneficiary populations and groups, and the interventions and actions that make up the services. Communication aspects of the delivery of a basic package of services include: clear signage, a helpful patient orientation, training for providers in non-judgemental communication, integrated community support and comprehensive sex education, and counselling on sexuality and self-care.

Click here to access this 70-page document in English in PDF format.

Click here to access this 70-page document in Spanish in PDF format.