Track F report by Alan MSOSA
Integration of SRHR and HIVAIDS must be context specific. Know your epidemic and develop and integration approach from that. Most organisations, however, face capacity challenges at the point of integrating SRHR and HIV services. They therefore need training and increased funding. However, the Macedonian experience suggested that depending on context, it is important to integrate already existing structures so as not to require too much additional resources.
Partnership and coordination is an important element for integration because that way there is optimisation of resources as well as combining comparative advantages between/ among implementing agents. One significant step in facilitating the integration is to integrate all relevant SRHR policies with that of HIV/AIDS. However, including integration into the national strategy does not necessarily guarantee implementation, mainly because government is slow to implementing strategies, as experienced in some African countries.
‘The challenges give us an opportunity to think about innovative approaches and work in a field that is mostly out of consideration in the work of HIV’ said a panellist from Colombia
There followed a general brainstorm on key elements for strengthening integration:
- Partnerships; to bring comparative advantages together, maximizing resources and funding opportunities
- Keeping up with needs of key populations
- Not looking at integration as a massive structural reform but rather try to maximize on what already exists
- Tracking integration progress in order to understand where you are and where you want to go
- Coordination at the local level to bring context into the puzzle
- Use the definition of health beyond medicine and biology!
Regarding questions on whether there is evidence showing that integration improves services; the panel pointed out that the current evidence is based on client satisfaction surveys and increase in clients to the integrated centres.
Youth report by Roli MAHAJAN
Integrating Sexual and Reproductive Health and Rights and HIV: Lessons from the field
Moderator: Maria Antonieta Alcalde (United States)
Panelists: Marieta de Vos (South Africa), Drasko Kostovski (Macedonia), Elizabeth Castillo (Colombia), Dudu Simelane (Swaziland)
The session was a discussion which promised to be interesting with a variety of panellists including a young person, Drasko Kostovski but it failed to deliver in terms of speaking more concretely of linkages and how that was happening at all levels.
The discussion began with the various panellists speaking about how they had started their work as both, individuals and organizations wherein Dudu Simelane spoke of how Family Life Association Swaziland had just been a small family planning organization while Elizabeth Castillo said that they had begun as health service providers on the field and had not planned on something so big. Kostovski added by saying that Health, Education, Research Association’s evolution was a natural process though not an easy one. He spoke of how in order to provide accessible care, support and treatment to young people, HESA had to broaden base.
When the discussion started loosing pace, the lively moderator, Maria Antonieta Alcalde moved the panelists towards the challenges faced by them when trying to integrate the services. This is when Marieta de Vos, Executive Director of Mosaic Training Service and Healing Center for Women, said that for a woman oriented organization they had to ensure that their counsellors could work with both males and women when they worked on issues like fertility planning, condom use and marriage counseling around HIV.
An important issue raised by Kostovski which highlights a challenge that a lot of youth organizations face was: talking about sexual health and specially topics like sexual rights. Youth organizations generally used building on needs of people as an entry point but then when they start integrating issues like sexual rights, stakeholders have problems with this because they do not see any relation between SRHR issues and health work.
The discussion then moved on to include small problems like clients having to wait for a refill creating a challenge (Swaziland) to involving new populations from the watchman to the lady who serves tea (Columbia) as being one.
The youth perspective was that youth initiatives do not face any hindrances when they just provide health services because even the governments have started to realize that the marginalized youth communities need care but hurdles appear when the question of rights comes into the picture. Donors see red and that’s when one has to deal with the whole baggage of public health. The need for Youth Friendly Services was underlined.
Inspite of some uncharacteristic, non-passionate and “non-youth-like” responses, Kostovski did manage to bring quiet a few facts to the table.
To conclude, each of the panelist was asked to mention one key element they wanted for strengthening integration:
- Dudu Simelane: Partnerships enhance interventions.
- Drasko Kostovski: Integrate all you have instead of being overwhelmed by massive structures.
- Marieta de Vos: Continue with interventions but track your successes and then move forward as well as coordination at all levels.
- Elizabeth Castillo: Broaden the definition of health to include not just the physical aspect but also the mental and psychological aspects.
INTEGRATION IS POSSIBLE!
LAPC report by Rich McKay
Panellists were invited by Maria Antonieta Alcalde (US) to discuss specific examples of integrated HIV and SRHR services in their countries, including origins, challenges, and important lessons. Marieta de Vos (South Africa) described how initial attempts to provide services to sexual abuse victims soon found that there were no integrated services; her organisation formed to fill that void. Elizabeth Castillo (Columbia) described a more gradual integration of HIV services into existing reproductive health services, a situation similar to that of Dudu Simelane (Swaziland). Drasko Kostovski (Macedonia) described how his organisation found that they could achieve greater capacity when they were able to link up with a wider SRHR field, and this built on their clients’ needs. EC found it challenging – but crucial – to position HIV, not as exceptional, but as part of a broader focus on health. DK emphasized that while support existed for HIV interventions, there was strong resistance to the idea that sexual rights were vitally connected to health. MdV and DS described systems challenges, from testing to information management, and that an increasingly wide provision of services has required increased training for service providers. DS said there was little external resistance to – indeed, much support for – her group’s extension into HIV services. MdV lamented that the connections between SRH and HIV are abundant, but that these are not acted on nearly enough. She argued that in a generalised epidemic, providers who offer integrated services may need to target particular clients, which sometimes means looking to less explored areas, like clients at abortion clinics who face increased vulnerability for HIV infection. As key lessons, DS and MdV emphasised partnerships and local co-ordination; DK and EC stressed that integration did not mean that organisations needed massive structure; instead ‘try to integrate whatever you have’.