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On the eve of the third Women Deliver conference taking place in Kuala Lumpur this week, the International HIV/AIDS Alliance has stressed the need to prioritise the sexual and reproductive health and rights (SRHR) of young women and girls under the age of 24 in order to have a greater impact on the HIV epidemic.
For women of reproductive age, HIV/AIDS is still the leading cause of death and HIV-related mortality accounts for one fifth of all maternal deaths. Globally young women aged 15-24 have HIV infection rates which are twice as high as in young men. Yet young women most affected by HIV — including those living with HIV, who sell sex or use drugs, and transgender women — are typically unable to access sexual and reproductive health and HIV services.
According to Felicia Wong, the Alliance’s Senior Advisor for Asia and Eastern Europe: “Young women and girls are all too often prevented from exercising their sexual and reproductive rights by factors such as community attitudes, early marriage, gender violence, and stigma and discrimination. This is particularly the case if they are living with HIV, sell sex or use drugs.
“Joining up family planning and HIV services not only saves lives but it also uses scarce financial and human resources more efficiently, improves overall health for women and girls, particularly for those from vulnerable and marginalised groups, and reduces the burden on health systems in the long run.”
Examples of integrated services include providing HIV and sexually transmitted infection (STI) testing and treatment in family planning and ante-natal clinics, and providing comprehensive services to prevent transmission from mother to child for pregnant women living with HIV.
The International HIV/AIDS Alliance, together with a consortium of international and national non governmental organisations, is currently spearheading an ambitious three year country programme – Link Up - which aims to improve the sexual and reproductive health and rights (SRHR) of more than a million young people living with and affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda.
Initial assessments from the programme conducted earlier this year indicate that stigma, discrimination and cultural taboos remain as critical roadblocks and that young people most affected by HIV do not feel safe or comfortable accessing services. All five project countries criminalise HIV transmission, drug use, same-sex relations and sex work and, as a result, neither national policies nor programmes can fully address the sexual and reproductive health needs of young people most affected by HIV.
The assessments also identified specific challenges such as frequent stock-outs of HIV test kits in Uganda and Burundi. In Bangladesh, health care workers reputedly disclose the HIV status of clients to others; behave rudely to them, particularly those from marginalised groups; and make disparaging comments about clients’ sexual behaviours.
Edith Mukisa, Executive Director of Alliance Uganda, said: “Uganda is primarily a young population, with nearly 80% under the age of 30. According to the 2011 Uganda Demographic and Health Survey, 58% of young women aged 18-24 had had sex before the age of 18, making them vulnerable to unintended pregnancies, HIV and sexually transmitted infections.
“Joining up youth friendly and integrated sexual and reproductive health services including HIV is a step in the right direction. Link Up will increase demand for SRHR services resulting in reduced unintended pregnancies, HIV and STIs, maternal mortality and morbidity among young women. Young people will also be able to access social protection and SRHR information through the programme.”
As Women Deliver 2013 opens, the Alliance is calling for the post-2015 development process to recommit to unmet Millennium Development Goal targets on HIV, child, maternal and reproductive health, and further commit to realising sexual and reproductive rights and linkages with HIV where appropriate.
Download a copy of the policy briefing Integrating HIV and sexual and reproductive health and rights: reaching and engaging the young people most affected by HIV.
