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1. International Technical Consultation on
Positive Prevention - GNP+ and UNAIDS
Criminalization of Status Session
Addressing Sexual and Reproductive Health and Rights and HIV
Prevention Linkages within Environments of Gender Inequality
Tunisia 27-28 April 2009
Lynn Collins
HIV/AIDS Branch, UNFPA

2. Human Rights: Universal & Inalienable
2

3. Percentage of most-at-risk populations reached with HIV prevention
programmes, 2005–2007
● 60% Sex workers
● 40% Men who have sex with men
● 46% Injecting drug users
“Recent research suggests that, while individuals often significantly reduce
sexual risk behaviours in the year following intensive, repeated individual
or small-group interventions, they frequently fail to sustain safer behaviours
for longer periods.”
“Nongovernmental informants in 63% of countries have laws, regulations or
policies in place that present obstacles to effective HIV-related services for
populations most at risk.”
3
At Risk/Vulnerable Populations
2008 Report on the Global AIDS Epidemic

4. ● Lack of economic
opportunity
● Gender based
violence/Coerced sex
● Biological susceptibility
● Lack of knowledge
● Femininity stereotypes
● Lack of empowerment
● Lack of access to sexual &
reproductive health
services & commodities
● Lower levels of
education
● Inability to negotiate
terms of sexual
relations
● Trafficking
● Inability to exercise
rights
● Harmful traditional
practices
● Lower status
● Child marriage and
early pregnancy
Young Women and Girls

5. Stereotypes foster:
• Risk-taking behavior
• Earlier sexual debut
• Unsafe sexual practices
• Reluctance to seek services
5
Masculinity stereotypes also affect men & boys

6. Global Strategies Gender & HIV
• 4/08 UNAIDS PCB “take immediate
action to develop specific tools to
assist countries in planning,
programming and implementing
interventions in the context of HIV
that address 1) women, girls and
gender inequality, and 2) men who
have sex with men, transgender,
bisexual and lesbian populations”
6
b
n
b
n
h
UNDP (lead agency UNAIDS Div. of Labour HR, gender and AIDS) &
Global Fund – parallel but related strategies
•Women, girls and gender inequality and HIV
•Men who have sex with men, transgender, bisexual & lesbian person

7. 2005 Conceptual Framework

8. SRH-HIV Linkages Matrix for Review of Evidence (IPPF,
UNFPA, WHO, UNAIDS, Cochrane Review Group)
Element 3 of
PMTCT
HIV
prevention,
education &
condoms
HIV
counselling
&
testing
Maternal & child
health care
7
8
15
10
STI prevention &
management
129
23
9
10
1
2
Other SRH services 0
5
1
2
0
1
GBV prevention &
management
4
10
1
2
1
2
Family planning 54
24
6
16
2
5
Clinical care
for PLHIV
2
3
4
2
2
0
1
1
1
4
Psychosocia
l & other
services for
PLHIV
1
4
5
2
1
0
0
1
6
5
Peer-Reviewed
Studies
Promising
Practices

9. ●improved access to & uptake
of key HIV and SRH services
●better access of PL HIV to
SRH services tailored to their
needs
●reduction in HIV –related
stigma and discrimination
●improved coverage of key
populations
●greater support for dual
protection
●improved quality of care
●decreased duplication of
efforts and competition
for scarce resources
●better understanding and
protection of individuals’
rights
●mutually reinforcing
complementarities in legal
and policy frameworks
●enhanced programme
effectiveness & efficiency
●better utilization of scarce
human resources for
health
Potential Benefits of Linkages

10. 2008 Linking SRH & HIV works
Cochrane Evidence Review:
• increases access to and
uptake of services
• improves health and
behavioural outcomes,
including condom use
• increases knowledge of
HIV and other STIs
• improves quality of
services
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11. Linkages
The bi-directional synergies in
policy, programmes, services and
advocacy between SHR and HIV
Integration
Refers to how different kinds of
SRH and HIV services or
operational programmes can be
joined together to ensure and
perhaps maximize collective
outcomes. This would include
referrals from one service to
another, for example. It is based on
the need to offer comprehensive
services.
Definitions

12. Linkages – More than Integration
Child marriage
Gender-based violence
Gender inequality
Human rights violations
Poor access to quality services
Coerced sex
Criminalization of HIV
Stigma and discrimination
Lack of empowerment/participation

13. UNAIDS 2008 Report on the Global AIDS Epidemic

14. UNAIDS 2008 Report on the Global AIDS Epidemic

15. Living 2008: The Positive Leadership
Summit, Mexico City, 31 July – 1 August
SRHR areas
a. “Rights to reproduction, sexuality and desire.
b. Articulating the SRHR dreams and desires of PLHIV.
c. Better linking SRHR efforts and actors with each other.
d. Emphasizing shared responsibility of PLHIV and HIV negative
persons for SRH decisions.
e. Challenging the changing face of stigma & discrimination.”
15
Main points of SRHR working group
a. “PLHIV are in need of empowerment regarding their SRHR
(knowledge, awareness of rights)
b. The SRHR discourse of PLHIV needs to be firmly anchored in
the human rights approach (violations of SRHR of PLHIV
occurring on a regular basis)
c. There is great diversity in SRHR issues of PLHIV - The SRH
needs & desires of PLHIV are as diverse as the epidemic itself.”

16. Advancing the SRH and Human Rights of People
Living with HIV: A Guidance Package (*)
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National legislative reform :
• antidiscrimination laws (sexual orientation, gender
identity, HIV status)
• decriminalization
• regardless of HIV status, right to marry and found a
family, non-relevance for divorce and child custody
• rights of young people to confidentiality, age-
appropriate information and SRH care
• women’s property rights guaranteed
• Sexual violence (e.g.incest, forced/early marriage,
sexual assault or rape) is recognized and
prosecutable
(*) EngenderHealth, GNP+, ICW, IPPF, UNAIDS, Young Positives

17. Advancing the SRH and Human Rights of People
Living with HIV: A Guidance Package (*)
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All people living with HIV (including marginalized
groups) should have access to a full range of sexual
and reproductive health services :
• all available contraceptive options including dual
protection, without coercion
• post abortion care and where legal safe abortion
• counselling and support for safe ways to become
pregnant and infant feeding
• diagnosis and treatment of STIs
• cancer prevention and care
• counselling and services for sexual violence
• sexual dysfunction treatment
(*) EngenderHealth, GNP+, ICW, IPPF, UNAIDS, Young Positives

18. Advancing the SRH and Human Rights of People
Living with HIV: A Guidance Package (*)
18
• Health providers should receive training in human
rights, universal precautions, and SRH PLHIV
• Health providers and advocates should support
closer linkages between HIV and SRH, harm
reduction, mental health, and anti-discrimination and
anti-violence services
• Governments, international organganizations and
NGOs in collaboration with young people living with
HIV should develop specific guidelines for
counseling, support and care for people born with
HIV as they move into adolescence and adulthood
(*) EngenderHealth, GNP+, ICW, IPPF, UNAIDS, Young Positives

19. Advancing the SRH and Human Rights of People
Living with HIV: A Guidance Package (*)
19
• Health providers should receive training in human
rights, universal precautions, and SRH PLHIV
• Health providers and advocates should support
closer linkages between HIV and SRH, harm
reduction, mental health, and anti-discrimination and
anti-violence services
• Governments, international organganizations and
NGOs in collaboration with young people living with
HIV should develop specific guidelines for
counseling, support and care for people born with
HIV as they move into adolescence and adulthood
(*) EngenderHealth, GNP+, ICW, IPPF, UNAIDS, Young Positives

20. Comprehensive PMTCT
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1) Primary prevention of HIV among women of childbearing age
2) Preventing unintended
pregnancies among women
living with HIV
3) Preventing HIV transmission
from a woman living with HIV
to her infant
4) Providing treatment, care and support to mothers living with
HIV, their children and families

21. ● Deliver comprehensive
package of PMTCT services
through SRH/STI/VCT
● Increase the availability and
quality of SRH programmes
● Integrate HIV counselling &
testing into SRH
● Provide high quality SRH to
women living with HIV
● Integrate SRH into ART
centres or strengthen
referral
● Provide FP counselling
and education during
ANC in all PMTCT
settings
● Provide FP counselling
and methods during PP
in all PMTCT settings
● Develop appropriate
guidelines, tools &
competencies for SRH
PLHIV in the context of
PMTCT
Operationalize links
between PMTCT and SRH
(pg. 21-22)
Guidance on Global Scale-Up

22. Stigma & Discrimination

23. 23
Stigma and Discrimination
People living with HIV will complete a questionnaire about their
perceptions of stigma in the following 10 key areas:
1. Experiences of stigma and discrimination and their causes
2. Access to work and services
3. Internal stigma
4. Rights, laws and policies
5. Effecting change
6. HIV testing
7. Disclosure and confidentiality
8. Treatment
9. Having children
10.Problems and challenges

24. from conceptualization
… to action
2008 Rapid Tool