The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding, while sexually transmitted infections can also affect HIV transmission.
Poor sexual and reproductive health and HIV share the same drivers, including socio-economic and gender inequality, social marginalisation of vulnerable populations and social and cultural sensitivities that complicate communication and evidence-informed action on all these issues.
A combination of better maternal and child health, reproductive health and HIV services on the one hand with structural measures to create a more enabling environment and greater demand for these services on the other, is required to bring about lasting changes in these long-standing problems.
Better linking of HIV and sexual and reproductive health and rights (SRHR) can greatly increase access to and up-take of information and a wide range of services, which is particularly important for women in Sub-Saharan Africa who account for nearly 60% of HIV infections in the region and have a lifetime risk of death during pregnancy and childbirth as high as one in 26.1
Improving linkages between HIV and SRHR can improve the lives of key populations affected by HIV2 and ensure that both women and men — whether they suffer from sexual and reproductive ill-health, are at risk of HIV or are living with HIV — have access to a continuum of services that meets their needs related to HIV and SRHR.
Integrating HIV and SRHR services contributes to, but also requires, strengthening health systems, but the wider agenda of linking policies and programmes on HIV and SRHR also requires a multi-sectoral and community-based approach, reaching beyond the health sector. Moreover, such efforts should be based on and can advance human rights and gender equality, for example by addressing gender-based violence and health needs, stigmatisation and marginalisation of people living with HIV and other affected and vulnerable populations.
1. Compared with a lifetime risk of one in 7300 in developed countries. ‘Women and Health — Today’s Evidence, Tomorrow’s Agenda’, World Health Organisation, 2009.
2. Key populations include, inter alia, injecting drug-users, men who have sex with men, sex workers and transgender people.