Inadequate SRHR Education or Inadequate Infrastructure: Which is the Limiting Factor?

This article was exclusively written for The European Sting by Ms. Neha Kasaravalli, a 22 year old Medical Student at the University of Manchester, UK and the National Liaison Officer for the Standing Committee for Medical Education between the UK and IFMSA She 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.

The issue of sexual and reproductive human rights (SRHR) transverses race. The taboo of discussing a sexually transmitted disease is a global issue and the stigma it brings with it affects those diagnosed universally. “Will I get HIV from kissing” still remains one of the top google searches – exemplifying worldwide misconceptions regarding the disease.  Whilst the fight against stigma is led by educating people on sexual health, consent and healthy relationship dynamics, we must not discount the importance of good local health infrastructure and implementation of adequate availability of contraception and medication.

My experiences working in both Western hospitals and African hospitals confounded this reality. Patient X, from Uganda, was aged 15 attending a genitourinary clinic in her nearest district hospital. She was silent with shock as she was told of her new diagnosis of HIV. “It was only one time.” The cliché echoes across the globe in genitourinary clinics everywhere. Patient Y, from the UK, was less silent, and more angry. “Will this kill me?” The difference for Patient X and Y is that it isn’t necessarily a death sentence for one of them. Unfortunately, 1.5 billion young people living with HIV in developed countries have only a 20% chance of living till the age of 60(1,2). Both of them, while lacking in education surrounding contraception, understood the impact of HIV on their life. Both of them received counselling; they needed to take regular anti-retroviral medication and use barrier methods of contraception to stop the spread. But it is not enough to empower people through education if condoms are not freely available. Another challenge remains with the lack of government funding or integrated SRHR and HIV response. This has resulted in increased reliance on ART provided by NGOs in developing countries(1).

Ultimately, improving access to treatment is not enough to end HIV once and for all, despite lowering the risk of transmission. For example, it was found that despite improving access to HIV antiretroviral therapy in Thailand, the prevalence of HIV in young people had not decreased like it was hypothesised to(3,4). Thus, prevention of HIV needs to be targeted to those who are high risk, and there must be investment into training primary healthcare administrators and mobilising funds for educational packages. This is also being encouraged by the WHO through the development of a toolkit(5). Evidence based prevention methods may be useful, like providing access to pre-exposure prophylaxis to at-risk groups. Furthermore, a legal framework is required to ensure that HIV is not criminalised and used unjustly to discriminate against those living with the condition. 

It is clear that more work is needed to ensure improved infrastructure for high quality universal healthcare coverage for sexual and reproductive health conditions. Nevertheless, the utilisation of education to break down cultural and religious barriers and negative stigma cannot be disregarded in its importance in reducing prevalence of sexually transmitted disease. After all, what good is providing a condom without teaching the wearer how to use it correctly? Therefore, both factors limit each other.

References

1. Kumar S, Mmari K, Barnes W, Birnbaum JM. Programming considerations for youth-friendly HIV care and treatment services. Washington, DC: The Elizabeth Glaser Pediatric AIDS Foundation; 2008.
2.  Global Statistics [Internet]. HIV.gov. 2020 [cited 25 November 2020]. Available from: https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics
3. 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(suppl_4):iv57-iv66. doi:10.1093/heapol/czw119
4. Unfpa.org. 2020 Sexual and Reproductive Health and Rights: An essential element of Universal Health Coverage[cited 25 November 2020]. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/UF_SupplementAndUniversalAccess_30-online.pd
5. World Health Organization. (2016). Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Available at: https://apps.who.int/iris/bitstream/handle/10665/246200/9789241511124- eng.pdf;jsessionid=A1CDD6F3746A7A05918A7115CBFAD5BC?sequence=1

About the author

Neha Kasaravalli is a 22 year old Medical Student at the University of Manchester, UK and the National Liaison Officer for the Standing Committee for Medical Education between the UK and IFMSA. She is very passionate about women’s health and is campaigning to reduce the stigma around sexual health education. She is also advocating for improved sustainable menstrual products to combat period poverty and their impact on women’s education.