Tài liệu The Contribution of Sexual and Reproductive Health Services to the Fight against HIV/AIDS:

FEATURES

The Contribution of Sexual and Reproductive Health

Services to the Fight against HIV/AIDS: A Review

Ian Askew,a Marge Berer b

a Senior Associate, Population Council, Nairobi, Kenya. E-mail: [email protected]

b Editor, Reproductive Health Matters, London, UK

Abstract: Approximately 80% of HIV cases are transmitted sexually and a further 10% perinatally

or during breastfeeding. Hence, the health sector has looked to sexual and reproductive health

programmes for leadership and guidance in providing information and counselling to prevent these

forms of transmission, and more recently to undertake some aspects of treatment. This paper reviews

and assesses the contributions made to date by sexual and reproductive health services to HIV/AIDS

prevention and treatment, mainly by services for family planning, sexually transmitted infections

and antenatal and delivery care. It also describes other sexual and reproductive health problems

experienced by HIV-positive women, such as the need for abortion services, infertility services and

cervical cancer screening and treatment. This paper shows that sexual and reproductive health

programmes can make an important contribution to HIV prevention and treatment, and that STI

control is important both for sexual and reproductive health and HIV/AIDS control. It concludes that

more integrated programmes of sexual and reproductive health care and STI/HIV/AIDS control

should be developed which jointly offer certain services, expand outreach to new population groups,

and create well-functioning referral links to optimize the outreach and impact of what are to date

essentially vertical programmes. A 2003 Reproductive Health Matters. All rights reserved.

Keywords: HIV/AIDS, sexual and reproductive health services, sexually transmitted infections,

health policies and programmes, integration of services

T

HE HIV/AIDS pandemic has had profound

effects on societies, individuals and families,

as well as on health programmes. As noted

by de Zoysa:1

‘‘At the societal level, AIDS is changing views

about sexuality, sexual behaviour and procre￾ation, and intensifying concerns about human

rights. At the level of the individual and the

family, AIDS is complicating sexual relationships

and threatening the ability to safely conceive and

bear children. For those engaged in service deli￾very, AIDS is changing priorities, increasing the

need to address the other sexually transmitted

infections, influencing recommendations on con￾traceptives, and frustrating abilities to counsel

clients seeking advice on issues as far-ranging as

infant feeding and partner relations.’’

With the HIV/AIDS pandemic showing few signs

of abating in the near future, especially in deve￾loping countries, governments and international

organizations have been planning multi-sectoral

approaches for prevention of HIV transmission,

and treatment and care for those living with HIV

and AIDS. Most commonly, it has been the health

sector that has taken a lead in these efforts,

including seeking ways of making antiretroviral

therapy accessible. In many countries, and within

most of the international donor and technical

assistance organizations, bodies that focus ex￾plicitly on coordinating HIV/AIDS activities have

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A 2003 Reproductive Health Matters.

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Reproductive Health Matters 2003;11(22):51–73

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been established. Given that approximately 80%

of HIV cases globally are transmitted sexually

and a further 10% perinatally or during breast￾feeding, the health sector has looked to sexual

and reproductive health (SRH) programmes for

leadership and guidance in preventing transmis￾sion, and more recently in offering some aspects

of treatment and care.

This paper reviews the existing contributions

of SRH programmes to HIV/AIDS prevention

and treatment—what efforts have been made

and how feasible, acceptable and effective they

have been. It is not intended to be an exhaustive

review but to illustrate the major types of con￾tributions made, mainly by maternal and child

health (MCH), family planning (FP) and sexually

transmitted infection (STI) services, and the posi￾tive implications for SRH policies and pro￾grammes of including attention to HIV/AIDS in

their operations.

Background

In 1994, the International Conference on Popu￾lation and Development (ICPD) adopted a plan of

action for achieving sexual and reproductive

health. Strategies to achieve this goal by 2015

are guided by the following short list of goals and

indicators, which were agreed upon by the United

Nations General Assembly’s Special Session

(UNGASS) on ICPD + 5 in 1999:2

All primary health care and family planning

facilities should offer the widest achievable

range of safe and effective family planning

methods, essential obstetric care, prevention

and management of reproductive tract infec￾tions, including sexually transmitted diseases

and barrier methods to prevent infection.
Where the maternal mortality rate is very high,

at least 40% of all births should be assisted by

skilled attendants; by 2010 this figure should

be at least 50% and by 2015, at least 60%. All

countries should continue their efforts so that

globally, by 2005, 80% of all births should be

assisted by skilled attendants, by 2010, 85%,

and by 2015, 90%.
Where there is a gap between contraceptive use

and the proportion of individuals expressing a

desire to space or limit their families, countries

should attempt to close this gap by at least 50%

by 2005.

By 2010 at least 95%, of young men and women

aged 15–24 have access to the information,

education and services necessary to develop

the life skills required to reduce their vulnera￾bility to HIV infection. Services should include

access to preventive methods such as female

and male condoms, voluntary testing, counsel￾ling and follow-up. Governments should use,

as a benchmark indicator, HIV infection rates

in persons 15–24 years of age, with the goal of

ensuring that by 2010 prevalence in this age

group is reduced globally by 25%.

Achieving consensus on the concept of sexual

and reproductive health was a major achieve￾ment of the ICPD; the major challenge subse￾quently has been putting this concept into

practice. It is relatively straightforward to define

the various health care services, including the

communication of information, that can improve

the conditions encapsulated within sexual and

reproductive health. It has proved much harder,

however, to develop feasible, acceptable, effec￾tive and cost-effective strategies for providing

these services, particularly given the primary

health care programmes in place in 1994. More￾over, in spite of many valiant efforts in this

regard, throughout the decade since ICPD, a

backdrop of health sector reforms, decreasing

funds from both national and international

sources for health care (including for sexual and

reproductive health services), and the urgency

to respond to AIDS, tuberculosis and malaria,

has created numerous obstacles.

Organisation of sexual and reproductive

health services historically

How have SRH services been organised histori￾cally and what changes have occurred since

ICPD? Which services are (or should be) included

in any definition of SRH services? A recent

unpublished strategy document from the World

Health Organization (WHO) Reproductive Health

and Research Department lists five key elements

as essential for addressing sexual and repro￾ductive health: ensuring contraceptive choice

and safety, improving maternal and newborn

health, reducing sexually transmitted and other

reproductive tract infections (STIs/RTIs) and

HIV/AIDS, eliminating unsafe abortion, and pro￾moting healthy sexuality. Other priorities include

I Askew, M Berer / Reproductive Health Matters 2003;11(22):51–73

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