ICAAP: Donors meet to talk about HIV and SRHR linkages

Participants at a satellite meeting during the 9th International Congress on AIDS in Asia and the Pacific agreed that programs, policies and funding for HIV and sexual and reproductive health and rights are disconnected, and discussed practical ways to integrate services and maximize limited resources.

The meeting featured a panel of representatives from donors and NGOs who spoke on effective ways to link sexual and reproductive health and rights and HIV. A key message from the session was that sexual and reproductive health and rights are essential to HIV prevention, treatment, care and support.

The meeting was hosted by the Asia Pacific Alliance (APA) and UNFPA. Moderated by Elisha Dunn-Georgiou (from Population Action International, an APA member based in Washington), the meeting was well-attended with more than 120 civil society representatives taking part in a dialogue with key donors working in Asia and the Pacific: the Global Fund to Fight AIDS, TB and Malaria, the David and Lucile Packard Foundation, Australian government aid agency (AusAID), the UN Population Fund (UNFPA) and the Sweden's International Development Agency (SIDA).

Many of the panelists spoke of the value that linkages and integration can add to HIV programming when dealing with ‘overlapping identities'. With HIV prevalence across the region largely concentrated among sex workers, injecting drug users and men who have sex with men, more integrated services can ensure people from overlapping and vulnerable population groups do not miss out on essential sexual and reproductive health services.

Panelists noted that integration was not a cure-all for challenges in Asia and the Pacific and that linkages sometimes increased burdens on health systems. All the speakers reinforced the need for responses to be driven by country-level and grassroots needs. ‘Knowing your epidemic' remained crucial, and all interventions need to be evidence-based.

Dr Robyn Biti, a Canberra-based HIV adviser for the Australian government aid agency, AusAID, said her agency had launched a new HIV strategy earlier in 2009. One of the six priorities in the policy encouraged was the integration of HIV into other health services, such as sexual and reproductive health, maternal and child health and chronic disease management.

AusAID is supporting work to integrate HIV into broader sexual and reproductive health services, particularly in Pacific Island countries, Papua New Guinea and Indonesia. Dr Biti said AusAID was soon to release new guidelines on family planning and reproductive health and said that it was important that sexual health is not just viewed through a HIV lens.

Dr Biti said that a priority recognized in AusAID's new HIV policy was encouraging policy change and legal reform to create a better enabling environment in Asia-Pacific countries for HIV prevention and sexual and reproductive health and rights.

Rikard Elfving, HIV adviser for the Asian Development Bank, said it remained important to address synergies between HIV and SRHR, particularly in ADB's support to health systems and HIV to ensure funding is most cost-effective. For the ADB, health is a second-tier priority. But the ADB works to support the implementation of HIV and gender in the planning and construction of major infrastructure projects in developing countries.

Anurita Bains, a senior adviser from the Global Fund to Fight AIDS, TB and Malaria said with the economic climate and declining resources money needs to be invested smartly. Integration makes sense and is more effective, Ms Bains said. However, with the Global Fund's country-driven application process, the need for integration needed to be clearly demonstrated at the country level.

Ms Bains said less than 20 percent of applications received by the Global Fund incorporated sexual and reproductive health and rights. The Global Fund remains committed to supporting civil society participation in the preparation of its proposals and in the implementation of activities.

Providing a civil society perspective, Sonal Mehta from the India HIV/AIDS Alliance said that linkages between sexual and reproductive health and right and HIV were obvious and common in many programs, but often donor policies made this more difficult.

Dr Michael Tan from the David and Lucile Packard Foundation noted that sexual and reproductive health and rights was not just a program but an approach. The essential rights component to programmes for HIV and sexual and reproductive health was often overlooked. Dr Tan said the Packard Foundation was developing a new strategy for population issues in light of the financial crisis. The Packard Foundation is preparing to scale back activities in Asia and the Pacific and will soon withdraw from the Philippines. The Packard Foundation would maintain a support base in South Asia.

Tomas Lundstrom, HIV Adviser from the Swedish International Development Agency (SIDA), said his agency was also looking to scale back funding in Asia and the Pacific, and that this was a trend for many European donors in the current economic climate. SIDA would still focus on encouraging democracy and human rights at a regional and global level, and would also expand its work around climate change.

When it comes to HIV and sexual and reproductive health in Asia and the Pacific, rights remained critical, Mr Lundstrom noted. Preventing HIV and programs for sexual and reproductive health and rights were often the same thing, and that Mr Lundstrom said he was always surprised there was so much fragmentation between the two areas.

Following the Global Fund's lead, Mr Lundstrom said many donors were now taking more of a ‘back-seat' position, and developing countries are increasingly encouraged to set their own plans, mindful of national contexts, priorities and capacities within individual health systems.

Several audience participants stressed the importance of rights in preventing HIV and in improving sexual and reproductive health and rights. A question was asked about what donors were doing to help remove legal and policy barriers in developing countries. The panelists, particularly bilateral donors, noted that while interventions focused on changing policy and promoting rights were very important, it was often hard to do as diplomatic partners.

Dr Chaiyos Kanunasont, HIV Adviser for UNFPA's regional office in Bangkok, said that government agencies, donors and civil society share one point of common ground, the need for good results and quality programs that reach people in need. Linking HIV and sexual and reproductive health and rights is the best way to optimise resources and deliver a comprehensive package of health services.