Integrating sexual and reproductive health and HIV programmes

What is integration? 

Integration is when HIV and sexual and reproductive health (SRH) information and services are provided together rather than separately. UNAIDS’ current strategy makes integrating HIV with other health services a priority.  

Integration can take many forms. These include: 

• providing education and information about HIV and SRH together  

• providing HIV and sexually transmitted infection (STI) services in family planning clinics or as part of antenatal care 

• providing family planning in HIV and STI clinics 

• ensuring HIV and SRH services are included in services to address gender-based violence. 

Why is integration important? 

HIV and SRH are closely linked: Integrating HIV and SRH services makes sense as both issues relate to sex and have many links. For example, most HIV infections are sexually transmitted, and HIV can also be passed on through pregnancy. Having an STI, especially one like herpes that causes sores, increases the risk of getting HIV. And experiencing gender-based violence or unintended pregnancy can increase people’s vulnerability to HIV and other STIs.  

Convenience: It is easier for people if they can get HIV and SRH services in the same place meaning more people are more likely to access these services. It can also save people who need services due to negative experiences having to repeat their story which can be traumatic.   

It can reduce stigma: For example, providing STI testing and treatment as part of antenatal services can make women feel more comfortable getting tested because they feel less judged in those spaces. While providing family planning services in HIV clinics might appeal to people with HIV if they are likely to be stigmatised in general family planning clinics.  

Cost-effectiveness and efficiency: Integrating services can save time and money as it avoids duplicating efforts and competing for resources.  

What does it aim to do? 

The aim of integration is to improve people’s access and uptake of both HIV and SRH services. It also enables programmes to meet a wider range of people’s needs. That’s why integrated services are sometimes described as ‘people centred’. 

When designing combined SRH/HIV services and support, it can be useful to work with the groups you are designing the services for to answer these questions: 

• What SRH and HIV challenges do people face? Is this different for different groups (such as different ages, sexualities, genders)? 

• What are the causes and consequences of these issues? Are these causes linked? What kind of interventions, services or support would address the causes of these issue?  

• What SRH and HIV services are currently available?  

• How well do these services address the issues of different groups? If there are gaps, how best can these be filled? 

[Adapted from Frontline AIDS’ good practice guide to integrating HIV and SRH services.] 

It is always the right of any individual to decide on their own healthcare. Though integration can be effective and offers convenience – it should be clear that people do not necessarily need to take up all the healthcare offered in any integrated service and they should not feel pressured to do so.

Different types of integration

What are the challenges? 

• Funding and policy: HIV and SRH services are often funded separately and have separate policies and guidelines.  

• Training needs: Healthcare staff don’t always have the skills and knowledge to provide integrated services. In some instances, they may also lack skills in dealing with certain stigmatised groups, such as sex workers, LGBTQI people, adolescents and people with HIV. 

• Demand: Simply providing integrated HIV/SRH services isn’t enough. People need to know that these services exist and the benefits of using them. 

• The need for complex integration: The most successful programmes often integrate a wide range of services and support. But this can be challenging to do.  

What are the solutions? 

• Advocating for clear policies, strategies and guidance for HIV/SRH integration. One of the most powerful ways to do this is to provide evidence on how integration would better address the issues policymakers are concerned about (such as HIV and STI infections and teenage pregnancies).  

• Conduct advocacy relating to SRH and HIV budgets to show policymakers how integration, and the training and resources to support it, would make services more cost-effective in the long run. The AIDS and Rights Alliance for Southern Africa has some useful guides on how to do this. 

• Finding low-cost solutions: It can take a long time to address policy and funding barriers. In the meantime, look for low-cost solutions, such as improving referrals between services. This can help join up services, even if they still run separately.  

• Community-led training: NGOs led by groups most affected by HIV are well placed to provide training for healthcare staff to change attitudes towards stigmatised groups.  

• Community-led demand generation: If integrated SRH/HIV services are available, work with community organisations to explain and promote these services to people in those communities. 

• Partnerships: Build relationships between community representatives, organisations, government departments and others that can play a role in HIV/SRH integration, and ensure regular communication to encourage joint working.  

• Better data: Gather data disaggregated by characteristics such as age, gender and sexuality. This can help identify gaps in HIV and SRH services and build the case for integration. 

Five ways to support HIV/SRH integration in community settings 

1. Outreach workers and peer educations can provide information and counselling on both preventing HIV and contraception. They can also provide condoms, emergency contraception and oral pills, and make referrals for other contraceptive methods, HIV/STI tests and (where available) safe abortion/abortion care. 

2. Adherence supporters can visit people with HIV at home or in groups to support them to take ART. At the same time, they can also provide SRH information, condoms, emergency contraception and contraceptive pills and make referrals to other SRH services.  

3. Peer educators can run education sessions and support groups on SRH and HIV. They can also meet with people one-on-one.  

4. Traditional healers and birth attendants can provide STI screening and treatment, basic antenatal and postnatal care (including information on contraception). They can also make referrals for HIV testing and treatment, safe delivery, and support for gender-based violence. 

5. Pharmacists can provide joined-up services, such as STI treatment, contraceptives and HIV/SRH information. Depending on the country’s laws, they may also be able to provide rapid HIV tests.