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Geneva, Switzerland, UNAIDS, 2016. 12 p.Gender inequalities and harmful gender norms are important drivers of the HIV epidemic, and they are major hindrances to an effective HIV response. While access to HIV services for women and girls remain a concern, a growing body of evidence also shows that men and adolescent boys have limited access to HIV services. Current effort to advance both gender equality and sexual and reproductive health and rights as key elements of the HIV response do not adequately reflect the ways that harmful gender norms and practices negatively affect men, women and adolescent body and girls in all their diversity. This in turn increases HIV-related vulnerability and risk among all of these groups.
Evolution of couples voluntary counseling and testing for HIV in Rwanda: From research to public health practice.
Journal of Acquired Immune Deficiency Syndromes. 2016;  p..Background: Couples’ Voluntary HIV Counseling and Testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda. Methods: From 1988-1994, pregnant and post-partum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and STI rates, particularly among HIV discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were re-introduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the PMTCT program expanded to >400 clinics. In 2009 the GoR adopted joint post-test counseling procedures, and in 2010 a quarterly follow-up program was established in government clinics with training and technical assistance. An estimated 80 - 90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections. Conclusion: Rwanda is the first African country to have established CVCT as standard of care in ANC. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda’s success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators and budgets. Governments, bilateral and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections. Copyright: 2016 Wolters Kluwer Health, Inc.
Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2012 Apr.  p.These guidelines recommend increasing the offering of HIV testing and counselling (HTC) to couples and partners, with support for mutual disclosure. They also recommend offering antiretroviral therapy (ART) for HIV prevention in serodiscordant couples. Recommendations include: 1.Couples and partners should be offered voluntary HIV testing and counselling with support for mutual disclosure (Strong recommendation, low-quality evidence). 2. Couples and partners in antenatal care settings should be offered voluntary HIV testing and counselling with support for mutual disclosure (Strong recommendation, low-quality evidence). 3. Couples and partner voluntary HIV testing and counselling with support for mutual disclosure should be offered to individuals with known HIV status and their partners (Strong recommendation, low-quality evidence for all people with HIV in all epidemic settings / Conditional recommendation, low-quality evidence for HIV-negative people depending on country-specific HIV prevalence). 4. People with HIV in serodiscordant couples and who are started on antiretroviral therapy (ART) for their own health should be advised that ART is also recommended to reduce HIV transmission to the uninfected partner (Strong recommendation, high-quality evidence). 5. HIV-positive partners with >350 CD4 cel ls/µL in serodiscordant couples should be offered ART to reduce HIV transmission to uninfected partners (Strong recommendation, high-quality evidence. (Excerpts)
Guidelines for integrating sexual and reproductive health into the HIV / AIDS component of country coordinated proposals to be submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria: Round 8 and beyond. Updated 18 February 2008.
[London, England], Interact Worldwide, 2008 Feb 18. 36 p.The Global Fund to Fight AIDS, Tuberculosis and Malaria, a unique multilateral partnership that has proven itself to be a successful mechanism for fighting these diseases, is an important funding vehicle for innovative responses to the three diseases, including SRH-HIV / AIDS integration. In preparation for upcoming and future Global Fund funding rounds, Guidelines for Integrating Sexual and Reproductive Health into the HIV / AIDS Component of Country Coordinated Proposals to be submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria is designed to support Country Coordinated Mechanisms (CCMs) to develop Country Coordinated Proposals for the Global Fund that integrate sexual and reproductive health into the HIV / AIDS component. (Excerpt)
Strategic considerations for strengthening the linkages between family planning and HIV / AIDS policies, programs, and services.
Geneva, Switzerland, WHO, 2009. 31 p.Many governmental and nongovernmental public health agencies are pursuing and, in some cases, scaling up programs that integrate family planning (FP) and HIV services. In response to calls from public-health decision makers for guidance on FP / HIV integration, the World Health Organization, the U.S. Agency for International Development, and Family Health International developed Strategic Considerations for Strengthening the Linkages between Family Planning and HIV / AIDS Policies, Programs, and Services. The partners drew from publications, the recommendations of more than 100 experts in FP and HIV / AIDS, and lessons learned from field experience. The document is designed to help program planners, implementers, and managers -- including government officials and other country-level stakeholders -- make appropriate decisions about whether to pursue the integration of FP and HIV services. It also explains how to pursue integration in a strategic and systematic manner, in order to achieve maximum public health benefit.
A practical guide to integrating reproductive health and HIV / AIDS into grant proposals to the Global Fund.
[Washington, D.C.], Population Action International, 2009 Sep. 61 p.Starting in recent proposal rounds, The Global Fund for AIDS, Tuberculosis and Malaria (GFATM) has stated more explicitly that countries can include reproductive health as part of their proposals on AIDS, tuberculosis and malaria, as long as a justification is provided on the impact of reproductive health (RH) on reducing one of the three diseases. This document is for countries and organizations, including CCMs, government and nongovernmental organizations and civil society organizations, to help in integrating reproductive health, including family planning (RH) and HIV / AIDS in proposals submitted to the Global Fund. The document takes a country approach to integration since the Global Fund seeks to support proposals that build on and strengthen national programs. (Excerpt)
New York, New York, UNFPA, . 48 p.This advocacy booklet provides real-life examples to illustrate how HIV prevention can save lives in diverse cultural and geographical settings. It includes chapters on youth and HIV, promoting and distributing male and female condoms, protecting women and girls, linking HIV prevention with other sexual and reproductive health care, and empowering populations who are at particular risk. The booklet features stories from Belize, China, Egypt, Ethiopia, Nigeria, the Russian Federation, and Tajikistan.
Lancet. 2007 Dec 1; 370(9602):1808-1809.Important questions about implementation of the new guidance by WHO and UNAIDS on provider-initiated HIV testing and counselling were raised by Daniel Tarantola and Sofia Gruskin. Their comments and those by other critics centre on individuals' rights to confidentiality, to refuse testing, and to not disclose their status if they fear negative consequences. We are concerned that a singular focus on the individual's rights of refusal overlooks the rights of the individual's sexual partners to protect themselves from HIV. Human rights and public health will be best served by an ethical framework which recognises that both persons in a sexual relationship or exchange have equal rights and responsibilities for their mutual pleasure and protection. Further, these individual rights are meaningless unless each partner respects the rights of the other. Protection of the human rights of both partners needs more commitment from health systems, and from societies, than simply ensuring informed consent and confidentiality. (excerpt)
Towards universal access: scaling up priority HIV / AIDS interventions in the health sector. Progress report, April 2007.
Geneva, Switzerland, WHO, 2007 Apr. 88 p.Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. Enabling people to know their HIV status; Maximizing the health sector's contribution to HIV prevention; Accelerating the scale-up of HIV/AIDS treatment and care; Strengthening and expanding health systems; Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. Antiretroviral therapy; Prevention of mother-to-child transmission of HIV (PMTCT); HIV testing and counseling; Interventions for injecting drug users (IDUs); Control of sexually transmitted infections (STIs) to prevent HIV transmission; Surveillance of the HIV/AIDS epidemic. (excerpt)
Program scan matrix on child marriage: A web-based search of interventions addressing child marriage.
[Washington, D.C.], International Center for Research on Women [ICRW], . 25 p.The international community and U.S. government are increasingly concerned about the prevalence of child marriage and its toll on girls in developing countries. One in seven girls in the developing world marries before 15. Nearly half of the 331 million girls in developing countries are expected to marry by their 20th birthday. At this rate, 100 million more girls-or 25,000 more girls every day-will become child brides in the next decade. Current literature on child marriage has primarily examined the prevalence, consequences and reported reasons for early marriage. Much less has been analyzed about the risk and protective factors that may be associated with child marriage. Also, little is known about the range of existing programs addressing child marriage, and what does and does not work in preventing early marriage. The work presented here investigates two key questions: What factors are associated with risk of or protection against child marriage, and ultimately could be the focus of prevention efforts? What are the current programmatic approaches to prevent child marriage in developing countries, and are these programs effective? (excerpt)
New York, New York, OSAGI, .  p.Her name is Joyce Puta, a 48-year-old Zambian army colonel on secondment to the United Nations. An unabashed fighter, her enemy for the last ten years has been HIV/AIDS. Her latest battleground is Liberia, and by all accounts she has been waging a successful campaign. Working with the United Nations Mission in Liberia (UNMIL), Colonel Puta points out that any environment requiring peacekeepers is also a risky one for the spread of HIV/AIDS. In post-conflict situations, social structures crumble and economies are unstable. In order to survive, desperate young women may turn to commercial sex work, often around military bases. So how did a career Zambian army officer find herself on the frontlines in the fight against HIV/AIDS? Joyce Puta joined the army at eighteen. Six years later she became a registered nurse and midwife, and then nursing services manager for Zambia's main military hospital. (excerpt)
Integrating sexual health interventions into reproductive health services: programme experience from developing countries.
Geneva, Switzerland, World Health Organization [WHO], 2005.  p. (Sexual Health Document Series)In 1994, at the International Conference on Population and Development (ICPD, 1994), 184 countries reached a landmark consensus on the need for a broad, integrated approach to sexual and reproductive health. Since that time, countries have been struggling to put the concept into practice. The first challenge has been to understand the broad concept of sexual and reproductive health, in order to identify the service interventions that should be added to an existing reproductive health (RH) or maternal and child health (MCH) programme to make it a sexual and reproductive health (SRH) programme. The second, more difficult, challenge has been to develop feasible, acceptable and cost effective strategies for providing these services within the existing, poorly resourced, primary health care programme base. To create SRH programmes, reproductive health services have to be expanded to better address sexual health. SRH programmes need to give attention to broader determinants of healthy sexuality and well-being. A recent WHO publication, Conceptual framework for programming in sexual health, offers a sexual health approach to service design and implementation. It stresses the need to recognize that not all sexual activity is for reproduction, and that other motivational factors, such as pleasure or a sense of obligation, are often more important determinants of individual sexual health and well being. To improve sexual health, programmes must address sexuality throughout the lifespan, from adolescence to old age, for both men and women. They must also recognize the role of power in sexual relationships and how it affects people's ability to make decisions about their own bodies and sexual life, free from violence, discrimination and stigma. Individual decision-making and the ability to make informed choices can also be limited by social, cultural and legal barriers. Broad sexual and reproductive health care services must recognize and begin to address these constraints through targeted interventions. (excerpt)
[New Delhi], India, NACO, 2004.  p.Voluntary Counseling and Testing (VCT) is the process by which an individual undergoes confidential counseling to learn about his/her HIV status and to exercise informed choices in testing for HIV followed by further appropriate action. A key underlying principle of the VCT intervention is the voluntary participation. HIV counseling and testing are initiated by the client's free will. Counseling in VCT consists of pre-test and post-test counseling. During pre-test counseling, the counselor provides to the individual / couple an opportunity to explore and analyze their situation, and consider being tested for HIV. It facilitates more informed decisions about HIV testing. After the individual / couple has received accurate and complete information they reach an understanding about all that is involved. In the event that, after counseling, the individual decides to take the HIV test, VCT enables confidential HIV testing. Counseling is client-centered. This promotes trust between the counselor and the client. The client is helped to identify and understand the implications of a negative or a positive result. They are helped to think through the practical strategies for coping with the results of the HIV test. Post-test counseling further reinforces the understanding of all implications of a test result. Counseling also helps clients to decide who they should share the HIV test result with, and how to approach that aspect. (excerpt)
Lancet Infectious Diseases. 2006 Dec; 6(12):760.It has been 21 years since the test that detects antibodies to HIV was developed, and in the ensuing decades, many millions of people have learned that they are infected with the virus that causes AIDS. But many, many more have not. Today, with almost 40 million HIV-infected people worldwide, UNAIDS estimates that globally, fewer than one in every ten people with HIV in developing countries knows their status. Those who do not miss out on treatment services, which are slowly expanding in even the poorest countries. In November, WHO/UNAIDS issued a draft of operational recommendations for an approach to HIV testing that is designed to redress this yawning gap. The approach is known as provider-initiated testing and counselling (PITC), and it suggests that health-care workers in countries with generalised epidemics, such as those in sub-Saharan Africa should encourage their patients in wards and clinics of all stripes to be tested for HIV even if they do not present with symptoms. The current standard for delivering HIV tests is client-initiated, meaning that individuals who wish to learn their status ask for the test. (excerpt)