This article was originally posted as part of a series on global AIDS issues to be published by RH Reality Check throughout December.
“We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach.” — President Barack Obama, May 5, 2009
On World AIDS Day, U.S. Global AIDS Coordinator Eric Goosby unveiled a five year strategy for global HIV/AIDS relief. Citing a shift in focus from an emergency response to sustainable in-country programming, Goosby told reporters at a press briefing that the new strategy will expand prevention programs and work towards strengthening national health systems.
Goosby’s call for a more sustainable approach to fighting HIV/AIDS globally is indicative of the growing movement towards aligning global health investments and long-term health system strengthening. In other words, the guiding principle for global health donors going forward should be that prevention and treatment for HIV/AIDS can no longer happen in isolation.
Beginning with the commitments made at the International Conference on Population and Development in 1994, and increasingly over the past 15 years, the international community has recognized that providing a broad constellation of health services in a single location will ensure a higher quality of care and positive health outcomes. For women, that means ensuring access to comprehensive sexual and reproductive health services.
Consider, for example, the circumstance of an HIV-positive woman in rural Botswana. In Botswana, which has the second highest HIV/AIDS prevalence rate in the world, most new infections occur in women. In order to obtain treatment, she must travel 30 kilometers by foot to a U.S.-funded clinic. The woman must travel another 50 kilometers to find a clinic that offers contraceptives that will enable her to control her own fertility or receive screening to detect cervical cancer, a disease that disproportionately affects women living with HIV/AIDS. Both clinics require separate staffing, infrastructure and overhead.
Currently, there are a number of global health initiatives that are prioritizing health systems strengthening. The US Global Health Initiative if successful, will seriously invest in women-centered approaches that can help provide for better sexual and reproductive health outcomes, and leverage significant support from other government donors and multilateral partners. The International Health Partnership is trying to build up strong health systems with coordinated investments in disease-specific responses, such as HIV, in a number of countries, primarily in Africa. Specific health-related initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, as well as maternal health, family planning, and child health initiatives, also need to examine how far they will go to expand their mandate to include broader health systems issues. in 1994, and increasingly over the past 15 years, the international community has recognized that providing a broad constellation of health services in a single location will ensure a higher quality of care and positive health outcomes. For women, that means ensuring access to comprehensive sexual and reproductive health services.
Civil society’s meaningful participation in building stronger health systems is crucial to both better health outcomes and greater accountability on the part of policymakers. The UNAIDS Operational Plan for addressing women, girls, gender equality and HIV will be rolled out shortly. During the three years it has taken to create a tool that both civil societies and countries can use to guide national efforts, civil society has been a strong advocate for an Operational Plan that both highlights the role that gender inequality plays in the pandemic and includes civil society organizations—including women’s rights organizations, sex workers, women living with HIV, and sexual and reproductive rights organizations— in decision-making processes. Going forward, civil society can use the plan to hold UNAIDS and national AIDS programs accountable to the needs of women and young people.
The world is now at a pivotal point of defining concrete actions to transform their funding and policies into tangible changes in women’s lives. Our program partners across Asia, Africa, and Latin America know what’s needed and what works. Access to sexual and reproductive health services is integral to good health for men, women, and young people, and underlies our ability to make headway in confronting other health issues as well. Foreign assistance donors and countries where they partner are shaping programs to integrate and invest in sexual and reproductive health – taking steps to end the political stigmatization of these programs and focus instead on the real-life health benefits.
All donors, including the United States, need to do more to increase investments in sexual and reproductive health services, including comprehensive sexuality education; support bold diplomatic programs for the human rights of women; and engage local organizations led by women and youth.
Alex Garita is IWHC’s Program Officer for International Policy. Read her bio here.