Strength in Unity

By Sidibe, Michel; Buse, Kent | Bulletin of the World Health Organization, November 2009 | Go to article overview

Strength in Unity


Sidibe, Michel, Buse, Kent, Bulletin of the World Health Organization


Recent increases in resources for achieving the goal of universal access to HIV prevention, treatment, care and support have given renewed impetus to the longer-standing political commitment for achieving targets in sexual and reproductive health and rights. As a result, we see increasing optimism that progress on these interdependent goals can be achieved--particularly if they are tackled together.

The AIDS response has been remarkably successful in transforming a deafening demand for inclusive policy processes and evidence-informed, rights-based programmes into tangible achievements measured in lives saved and dignity restored. The most visible manifestations of these achievements are the more than 4 million people presently on antiretroviral treatment and the tremendous advances in overcoming the stigma and discrimination faced by people who inject drugs, men who have sex with men, and sex workers and their clients.

It is encouraging to see evidence that well designed AIDS responses can and do strengthen health systems. (1) Nonetheless, evidence also confirms that greater and more systematic efforts must be made to take AIDS responses out of isolation to support wider health, development and human rights agendas.

Fostering improved linkages is also critical to the AIDS response. Despite treatment successes, we will not turn the tide on the epidemic, which sees five new people infected with HIV for every two individuals starting treatment, unless prevention is intensified. This can be achieved in part through service integration, which achieves more cost-effective resource allocation and responds to people's desires for a seamless and comprehensive continuum of care.

There are several linkages between HIV and sexual and reproductive health responses. Services to virtually eliminate mother-to-child HIV transmission provide an ideal platform to deliver the entire recommended minimum package of antenatal, maternal, child health and reproductive health services. This would ensure that pregnant women are not only offered HIV screening, but that they and their partners are also offered services to prevent HIV and other sexually transmitted infections, unwanted pregnancies and sexual violence.

Calls for integration are not new. The global community reached consensus on the need to provide holistic sexual and reproductive health services as far back as 1994 with the Programme of Action of the International Conference on Population and Development. The need has been further reaffirmed in important global declarations since then--notably the United Nations Political Declaration on HIV/AIDS of 2006.

Increased integration is intuitively appealing and enjoys a great deal of scientific support for the benefits it can deliver. (2) These include increasing coverage, and thereby access, at lower cost as well as improving quality of care and acceptability for often stigmatized conditions. WHO, the United Nations Population Fund, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other partners have supported countries to increase service integration within national programmes. …

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