PCB Thematic Session Summary SRH and HIV Linkages

1. PCB Thematic Session SummarySRH and HIV Linkages

2. Comprehensive Sexuality Education (CSE) • Lack of recognition of sexual and reproductive rights of young people • Legal barriers prevent young people accessing CSE and SRH/HIV services • “Political will is fundamental and it doesn’t cost anything” • Misinformation about what CSE is, its impact and importance

3. CSE means: • Rights-base • Age appropriate • Gender transformative • Evidence-informed • Promotes self-esteem and empowerment • Biological aspects of puberty • Sexuality • Contraceptives • Options for unintended pregnancy • STIs/HIV • GBV • PLHIV • Skills for (avoid coercion, negotiate safe etc.) • Community/parents

4. Integration of Services • Bi-directional service integration can work – no one model • Coordination mechanisms are essential • Human resources – training and retention (multi-tasking, task-shifting, attitudes…) & commodities “integration by default” • Understanding integration in low and concentrated epidemics • Tailoring services for people living with HIV, key populations, and young people • Services for and involving men • Reduction of stigma and discrimination

5. What is being integrated? (Kenya)

6. Funding Opportunities for Integration • ‘Shift in the balance of power’ - country ownership for contextual solutions vs. restrictive/conditionalities of donors • “No such thing as a fully integrated or fully vertical system” – bottom line is comprehensive responsive to clients • Importance of global voices, especially around human rights, e.g. engagement principles • Funding driven artificial separation of SRH & HIV • “What we need most is integration of donors”

7. “Integration is not itself an end but a means” to achieve… • Universal access goals • Health outcomes • Human rights • Programme effectiveness/efficiency • Link between community and health interventions • Elimination of stigma and discrimination

8. GBV and HIV • GBV is an intrinsic human rights violation and intersects with HIV • Inclusive definition of what constitutes GBV (MSM/SW/TG/) • Stigma and discrimination, social exclusion and shame associated with GBV • Strengthen advocacy – influence (CSOs, FBOs, etc.) • Build capacity, to address the link between GBV and HIV especially in humanitarian settings • Need for more data collection and research • Multisectoralresponse legal reform, policy and programmatic (law enforcement (police, military), health, CSE, etc.)

9. Support the integration of SRH and HIV services - sustainable financing, harmonized policies and good practice • No one model and integration is not a panacea • Commitment by all relevant stakeholders • Coordination mechanisms and inclusion of stakeholders • Joint planning for harmonized approach • “Movement in direction of success = put in more resources” • Initially may be increased cost/allow time for change • Human resources, training and retention of health professionals, (knowledge, attitudes & practices that uphold human rights). • Community and health systems strengthening

10. Include relevant services and systems beyond the health sector • CSE - UNESCO’s International Technical Guidelines on Sexuality Education • CSE and YFS linked - requires MoH and MoEto work together • “Prevention revolution must include CSE” (e.g. LAC Ministerial Declaration “Educate to Prevent”) • Full implementation of the Agenda for Women and Girls • Health , psycho-social, judicial, law enforcement systems to address GBV and HIV

11. Support collaborative action research to address key gaps • Health outcomes • Stigma reduction • Cost-effectiveness • GBV • Men and boys • Integration in low and concentrated epidemics • SRH people living with HIV and key populations • “If we wait for evidence to catch up we will constantly be reactive…”

12. Strengthen ties between maternal, newborn & child health initiatives & HIV • Favourable political enviornment • Comprehensive 4-pronged PMTCT • Maternal and child survival/virtual elimination • HIV integrated into ANC, PP, FP, etc. • Address stigma and discrimination • Rights of people living with HIV • Comprehensive universal SRH • Low/concentrated epidemics

13. Ensure linkages for key populations (including in low/concentrated epidemics) • Design and implement services need to do more to meet the needs of key populations (access, rights, etc.) • Direct funding to community based organizations, better at reaching and gaining trust of key populations • Advocacy to serve a broad constituency (universal access) • Engagement in policy making and programming • Legal/policy reform (e.g. end criminalisation)

14. Remove punitive laws, policies, practices, stigma & discrimination that block access to integrated SRH and HIV services • Legal audit and law reform, access to legal services, programmes to reduce stigma and discrimination, know your rights/ law campaigns and training of key service providers • Non-discriminatory, inclusive, participatory, and accountable • “Doesn’t cost a lot being brave on these issues” • “Stand up for universality of human rights!”