The AIDS epidemic is integrally linked to sexual and reproductive health: The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding. Both HIV/AIDS and poor sexual and reproductive health are driven by common root causes, including poverty, gender inequality and social marginalization of the most vulnerable populations. Responses to both health issues should be closely linked and mutually reinforcing.
UNFPA, along with the rest of the international community, strongly advocates for closer linkages between HIV/AIDS interventions and sexual and reproductive health care. This makes sense in terms of public health benefits, economic efficiency and human rights. Integration of services is called for in a major UNAIDS policy position paper. The idea was reaffirmed at the 2005 World Summit when world leaders identified universal access to reproductive health as a component of combatting HIV/AIDS and achieving the other Millennium Development Goals.
Stronger linkages between sexual and reproductive health and AIDS programmes should lead to a number of important public health benefits:
Improved access to, and uptake of key services
Better access of people living with HIV to services tailored to their needs
Reduced AIDS-related stigma and discrimination
Improved coverage of underserved and marginalized populations, such as injecting drug users, sex workers or men who have sex with men
Greater support for dual protection against unintended pregnancy and sexually transmitted infections, including HIV, for those in need, especially young people
Improved quality of care
Enhanced programme effectiveness and efficiency
Linking HIV and AIDS interventions with general reproductive health services can strengthen both. Both types of services face the same health system challenges: shortages of trained staff, essential supplies and equipment, adequate facilities, and management skills. Both face similar obstacles in dealing with sensitive or taboo subjects. They both require similar supplies and the same types of health provider skills.
More comprehensive services would be a convenience, perhaps a lifesaver, to individuals who have limited access to sexual and reproductive health care. The poor typically receive only piecemeal information and services - even though they may have urgent concerns regarding both HIV and other reproductive health issues. Many argue that offering a minimum package of services under one roof is the best way to meet their pressing needs and protect their right to health.
In sub-Saharan Africa, where the AIDS epidemic is widespread, 63 per cent of women have an unmet need for effective contraception and, consequently, a high proportion of unintended pregnancies. Many of these women do not know their HIV status, have limited access to information and services, and thus risk passing the virus to their children. Under these circumstances, access to even a minimal integrated package of care - including family planning, management of sexually transmitted infections, HIV prevention and maternal health - can enable women to protect themselves from both unintended pregnancies and HIV and also prevent HIV transmission to their children. Integrating HIV/AIDS services into sexual and reproductive health and rights is one of many steps called for by the Maputo Call to Action.