In October, an alarming article in The Lancet by Heffron et al reported that women using injectable contraceptives were twice as likely to either pass HIV to their sexual partners or were twice as likely to become infected themselves.
Although there have been previous studies indicating there is some connection between the use of hormonal contraceptives and HIV susceptibility, none have been able to mobilise the international community like the Heffron study has. As a follow-up, the World Health Organization is holding a meeting with family planning organisations and hopefully HIV organisations, as well, to determine what action is needed.
Integrating HIV services and sexual and reproductive health
Thirty years into the epidemic, Heffron’s article once again reminded us that HIV cannot be addressed in isolation. Since the beginning, we have known that adequately addressing HIV also means appropriately addressing individuals’ sexual and reproductive health needs and rights (SRHR). The SRHR and HIV sectors are still not effectively making strides together to maximise resources and experiences to jointly achieve improved SRH and HIV outcomes.
Why it has been so difficult to provide integrated services?
Of course, there are many levels of complexity as to why it has been so difficult for health professionals and civil society groups working in SRHR and HIV to provide holistic services and support to individuals and communities. From ever changing donor priorities to vying for an ever-shrinking funding pie, an ‘us vs. them’ mentality has developed between SRHR and HIV. Many of us are now struggling to overcome this fragmentation in the SRHR and HIV response.
Throughout 2011, the optimism and momentum has grown that we have the key ingredients to ‘getting to zero’. We have political commitment, effective funding approaches and new technology to bring an end to AIDS and new HIV infections.
- Governments reaffirmed high level commitment to fight HIV and AIDS at the UN General Assembly High Level Meeting on AIDS;
- New investment framework for HIV which shows that if we invest in the right approaches, at the right level, we would actually see a significant drop in new HIV infections and be able to end HIV within the next generation;
- HPTN 052 study showed that antiretroviral therapy (ART) can decrease HIV transmission among sero-dicordant couples by 96%.
HPTN 052 demonstrates that the treatment vs. prevention dichotomy has never made sense and that scaling up treatment is scaling up prevention. Clearly, treatment as prevention in combination with other proven prevention approaches both gives us the tools to treat people already living with HIV, as well as prevent millions of additional infections. This approach is good for individuals, makes financial sense and gives us hope for ending the HIV epidemic.
We must act now to save more lives
We now have to convince donors, policy makers and ourselves that working smarter together across health and development, and funding what works will ultimately result in saving millions of lives and improving quality of life for communities most vulnerable to HIV and other sexual and reproductive ill health, especially marginalised communities and people living with HIV.