The INFO Project Blog

 The day  started with a session entitled “Positive Prevention” which discuss  how highly active antiretroviral therapy (HAART) can be used as a factor to decrease HIV infections. Research studies have shown that those who are adherent to HAART therapy and have an undetectable viral load are at low risk for passing HIV to someone else.  Research has shown that the risk of contracting HIV from someone on HAART with an undetectable load is extremely small, about 1 in 100,000.  The use of HAART and condoms has been shown to be more effective in preventing HIV transmission than the use of condoms alone.

Following this session, I got on a bus to downtown Mexico to take a trip to Mexfam.  Mexfam is a private network of sexual and reproductive health clinics throughout Mexico. Mexfam can be found in 17 states throughout Mexico and provides services mainly to marginalized populations.  Mexfam has over 500 staff and 1,000 volunteers throughout Mexico.  Mexfam has a history of providing sexual and reproductive health services to youth. 

Mexfam provides family planning counseling and methods to clients at a discounted charge, in addition to gynaecological exams, pregnancy testing and HIV/STI testing.  Mexfam, Mexico City where I visited provides gynaecological exams, condoms, IUDs, implants, pills and injectables.  If a client wanted a permanent method they would be referred to a central clinic with surgical capacity.  In terms of integration, if a client is found to be HIV+ they are referred to La Clinica de la Condesa, one of the largest and most comprehensive HIV clinics in Latin America.Mexfam also is a leader in promoting breast and cervical cancer screening for young women. 

I was excited to see that Mexfam had both a copy of the Essentials of Contraceptive Technology, The Family Planning Global Handbook for Providers and the Contraceptive Wall chart hanging on a door of a consultation room.

Mexfam also works with Mexican schools to provide comprehensive sexual health education in schools.  In 2007 Mexfam had provided over 100,000 couple-years of protection and almost 2 million total contraceptives.

In the afternoon, upon returning, I attended another session which focused on reaching diverse populations of men who have sex with men (MSM) in low and middle income countries.  Research and programs from China, Peru, Malaysia and Uganda were discussed. 

The final session of the day once again focussed on integration and was a satellite session entitled “Linking Sexual and Reproductive Health and HIV.” The highlights of the two hour session are as follows:

• Linking SRH and HIV: Evidence Review and Recommendations, Gail Kennedy: This presentation was the same literature analysis that was presented yesterday and that I summarized carried out by IPPF, UNFPA, WHO and several other partners.  Although the review identified gaps in research, the review showed that integration generally achieved positive results.
• PMTCT: The most complex and the most simple of programmatic entry point sfor linkages, Dr. Lynn Collins, UNFPA: It is difficult to know where there is a difference between HIV and SRH elements of PMTCT.  Primary prevention is a basic element of PMTCT and should not be left to general HIV prevention programs.  As a part of PMTCT mothers should be offered safe sex counseling, STI diagnosis, condom and condom negotiation skills.  The provision of rights based family planning (not coerced sterilization) is critical, but there needs to be a measure measuring FP uptake and provision of unmet need as a part of PMTCT programs.  Ensuring the reproductive, sexual health and human rights of women living with HIV/AIDS is the joint responsibility of HIV/AIDS and SRH programs.
• ART Delivery: Providing ART in a Sexual and Reproductive Health setting, Dr. Hugues Lago, IPPF, Kenya: The provision of HAART was integrated into Family Health Options Kenya’s   Comprehensive Care Clinics, which already provided SRH services such as antenatal care and STI management.  Staff was trained by the MOH and the staff was motivated to provide the new integrated services.  Providing ARV at HIV/STI clinics attracts new clients and creates opportunities to promote SRH to a wider population.  Promoting ART and SRH is possible, plausible and practical. 
• Structural Interventions for HIV and SRH Integration, Charlotte Watts, London School of Hygiene: Structural intervention targeting gender inequity and poverty reduction are helpful to improving sexual health and preventing HIV. Women in South Africa were provided small loans as part of a microfinance program.  At each repayment session, women were trained on issues of gender, violence and HIV transmission.  An evaluation of this unique program showed that the combination of microcredit loans and SRH/HIV education reduced physical and sexual partner violence and HIV risk behavior and increased uptake of VCT.   HIV/SRH integration is about more than just service provision - national programs should respond to structural factors of HIV transmission.
• Dreams and Desires: The Sexual and Reproductive Health Needs of People Living with HIV: Kevin Moody, Netherlands:  This presentation outlined findings that came out of several recent consultation of people living with HIV/AIDS.  HIV positive individuals have the right to access services,  such as support and counseling, and STI treatment and screening;  the right to information about sexuality and HIV criminalization laws, and the right to make a choice about whether or not to reproduce.  Linking HIV and SRH is part of the core business of the HIV community and the SRH and HIV communities both have a shared responsibility of prevention.