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In an ideal world, a woman or girl would be able to walk into a “one-stop-shop” clinic and have all of her health needs met, with respect for her sexual, reproductive and human rights. In order to achieve this goal, funding streams, public policies, and advocacy strategies must also be integrated. (Prevention Now Report)
On September 2 in Washington, DC, CHANGE and AVAC launched the Prevention Now report, which lays out critical actions to better integrate and coordinate advocacy for improved prevention for women and girls. This report is the product of a meeting convened by CHANGE and AVAC in June 2015 in Nairobi that brought together a dynamic group of advocates from across sub-Saharan Africa and the US. Participants included women who lead advocacy efforts on sexual and reproductive health and rights (SRHR), HIV prevention and treatment, gender-based violence (GBV), sex worker health and rights, youth health and rights, maternal health, and abortion access organizations. Participants gathered to develop an advocacy agenda around integrating women’s health services. Perhaps one of the most exciting aspects of this meeting was that so many of us had not met each other before, yet work on similar issues: further evidence on the schism between advocates working in HIV, SRHR and GBV.
It’s a schism that makes no sense in the real world. Preventing unwanted pregnancy and HIV transmission are inextricably linked in the lived experiences of women and girls yet family or fertility planning, STI, HIV, and maternal health funding and service delivery and advocacy are often disconnected.
As the field wrestles with delivering HIV prevention options that women and girls want and can use, it’s critical to remember that women do not think of HIV or prevention as a singular specific issue. Women’s (and everyone’s, for that matter) lives are not compartmentalized in the way that services and product development often are.
There’s a lot of talk, globally, about prevention for women and girls. A myriad of global strategies directly refer to women—the PEPFAR DREAMS Initiaive; the UNAIDS Action Framework Addressing Women, Girls, and Gender Equality; the United Nations Strategy on Maternal and Child Health; Family Planning 2020; and the new Structural Development Goals. But this talk, for now, doesn’t translate into enough action.
There is also HIV prevention research focused on young women. Ongoing and planned studies are exploring microbicides, multi-purpose prevention technologies (MPTs), long-acting injectable ARVs for prevention and HIV vaccines. Many of these studies are focused on or include women. And there are a range of “demonstration projects” designed to learn more about daily oral PrEP in the real world, many of these enrolling women — offering the first strategy that a woman can use for HIV prevention that doesn’t require partner negotiation at the time of sex. Up next are results are expected from trials of the vaginal microbicide dapivirine ring in early 2016. Also beginning this year is the ECHO trial that will study the possible relationship between HIV and long-acting hormonal contraception.
All of this means there are ample opportunities — and needs — for advocates to influence the implementation of SRHR and HIV integration strategies and research initiatives and to advocate for a new paradigm in which donors, policymakers, researchers and providers understand and act on women’s SRHR needs and preferences.
Participants at the Nairobi meeting in June looked at barriers and opportunities and proposed creative strategies to address and take advantage of them. The meeting report launch in DC this September brought those recommendations to US-based policy makers, advocates and implementers in the room—and sparked a discussion about next steps in the US and global context.
Over 30 participants in DC from the HIV and SRHR worlds discussed and compared barriers to more integrated advocacy. Topics included the pressure to respond to donor-driven agendas, some of the discontent in the SRHR world on the increased amount of funding for HIV vs. the drying funding streams for SRHR, the fear of diluting “the message” when integrating agendas and just the sheer amount of work to be done. One participant—a long-time HIV activist herself—noted that it was time for HIV advocates to do the hard work of building the case for SRHR advocacy and funding and play a more prominent role in making the inroads into SRHR work. Echoing the discussion in Nairobi, the DC participants noted the importance of “power-building” young women to lead the charge in integrated advocacy efforts and underscored the need to include frontline clinicians in the dialogue on integration.
Integration is a development buzzword. It sounds like a pretty technical term to many and means different things to different people. Depending on who you ask, it can mean combining budgets, work plans, staff training, counseling and public education messages for diseases, health needs or populations that are, inexplicably, often treated in siloes. So, for example, there are active conversations about integrating TB and HIV services; integrating HIV and broader sexual and reproductive health (SRH) services; ensuring that sexual and reproductive rights are integrated into all services; looking to integrate assessment of gender-based violence into services; ensuring cervical cancer screening, prevention and treatment is included; integrating services for adults and children under one roof... and the list goes on...
The bottom line for advocates is clear: If we want integrated services, we need integrated advocacy. As HIV prevention advocates we must challenge ourselves and others to go beyond lip service when considering what it would take to deliver new HIV interventions to women and girls. When we talk about an integrated package of interventions we need to understand what that means, to be able to describe what the package looks like and potential delivery challenges. (See resources on ongoing Integration initiatives below.)
What’s the one simple thing you can do today towards integrated advocacy? Is there a word or phrase you can add to your HIV prevention message? Is there someone from a cervical cancer screening program you can invite to your next meeting? Read the report, it may inspire you.
Resources on Integration HIV/SRHR Initiatives