This article was exclusively written for The European Sting by Mr. Francisco Duarte, a 5th-year Medical Student from the University of Beira Interior, Portugal. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.
Ending HIV and SRHR: what is the link? We can look and analyse it through a 3-way dynamic that encompasses legal and policy action, health systems and service delivery. This model shows that by taking legal and policy action that allows the linkage of HIV and SRHR services, we can promptly improve our health system to work upon joint strategies, making it easier for a broader service delivery to the population.
By acknowledging HIV health services as an integrated part of SRHR, it should be quite easy to improve both by applying many suggestions and recommendations that have been made throughout the years. Despite that, there are some inherent difficulties to this dynamic.
Legally, there is a separation between SRHR structures and HIV ones. This hierarchization of services makes joint actions and resources allocation even harder. In addition, SRHR can have a complex scope of action, although there are quite few SRHR strategies itself. Considering these few strategies, there are even fewer dedicated to HIV as part of SRHR. The lack of SRHR and HIV intersectional joint strategies makes it impossible for health systems to develop actions and define goals to improve HIV and SRHR status. That being said, if no joint actions are being put in place, service delivery will be lacking and there will be no beneficial outcomes.
Being aware of what is missing to ensure the end of HIV and improvement of SRHR, is of utmost importance to tackle these issues.. We can briefly analyse the importance of it through the Sustainable Development Goals for 2030. SDG3 makes us take a closer look at UHC. If people are unable to access healthcare related to HIV, UHC is not ensured. That way, SGD3 aims for the promotion of health equity and the integration of rights-based services. SDG4 shows us that by improving the quality of CSE, we aim at more responsible and informed health decisions. SDG5 stands for gender equality, and we know that HIV is the leading cause of death among women of reproductive age. It aims for gender-transformative HIV programmes which can diminish violence and empower women.
So, what is still left to do? How can we improve SRHR and the status of HIV policies? Shall we go back to the 3-way dynamic?
If we take a look at the legal and political axis, SRHR and HIV entities should work within the same structure, diminishing the void between them. This way, this horizontalization of action, allows for better funding, increasing resources to take bi-directional actions.
When it comes to health systems, they should aim for more comprehensive and resilient care, supporting PLHIV, thus increasing their SRHR status. This can be done through the application of evidence-based information and an integrated model for delivering primary health care services including SRH and HIV.
Finally, guaranteeing this primary health care service’s delivery is ensuring UHC. It ought to be applied in a joint methodology, linking SRHR and HIV services together in a life-course approach.
References:
- Hopkins J, Collins L. How linked are national HIV and SRHR strategies? A review of SRHR and HIV strategies in 60 countries. Health Policy Plan 2017, 32: iv57–iv66. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886072/
- AIDS and the Sustainable Development Goals, available at https://www.unaids.org/en/AIDS_SDGs
- WHO. Call to action to attain universal coverage through linked sexual and Reproductive health and rights and HIV interventions. 2018; Available at: https://www.who.int/reproductivehealth/publications/call-to-action-linked-srhr-hiv-interventions/en/
About the author
Francisco Duarte is a 5th-year Medical Student from the University of Beira Interior and the National Officer on Sexual and Reproductive Health and Rights including HIV and AIDS Medical of the Portuguese Medical Students’ National Association, ANEM- Portugal, National Member Organization of the International Federation of Medical Students Associations. Alongside with his Medical studies, he has been an advocate for SRHR, developing several initiatives that aim to raise awareness for topics such as HIV, AIDS, and Maternal Health, namely Obstetric Violence.
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