SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...

BANGLADESHCAMBODIANEPALPHILIPPINESVII. ISSUES ANDCHALLENGESIn the context of a rights-basedapproach to health programming,Nepal’s challenge is compounded byproblems of low coverage of overallhealth services, geographic diversityrestricting access to healthcare, widespread poverty, and ramifications ofthe decade long conflict. These requirediscussions between governmentagencies and EDPs, to clarify howNepal is going to move forward interms of approaching the rights-basedsystem of health care delivery.There is a need for greater coordinationbetween SRH and HIV during the policyand strategy formulation processes.Such coordination is necessary to betterleverage on the strengths of both fieldsin service provision, in these times ofweakened health systems and verticalprogrammes. Many of the efforts tolink the two fields have been curtaileddue to lack of interest from both SRHand AIDS organisations. Territorialinterests of stakeholders and lack ofpolicy guidance from MoHP have beenthe major barriers to better linkage.While women and adolescents have beenthe focus, provision of comprehensivesexual health services for these groupshave had limited coverage. There havebeen and continues to be a lack of sexualhealth services for men. In fact, men’ssexual health has been largely ignored.Men and women are influenced by sexualconstructs and gender norms particularto their own social contexts, leavingmen vulnerable to risky behavior andinfection with HIV or other STIs. Yetmen, unlike married women, have littleor no access to reproductive and sexualhealth services. While programmes areincreasingly including adolescent boysand girls, mainstreaming of programmesby AIDS and SRH organisations hasbeen slow to address the sexual healthneeds of adult men.Bi-directionality, both the SRH and theHIV communities addressing relevantaspects of each others’ agendas hasbeen one of the hallmarks of linkages.Therefore, it is expected that linkedresponses could favourably impact onboth SRH and HIV outcomes. Suchresponses include but are not limitedto: rights-based family planningin the context of mother-to-childtransmission of HIV programmes,ending gender-based violence and childmarriage, providing HIV voluntarycounselling and testing within antenatalcare, promoting condoms for dualprotection within family planning andHIV programmes, and comprehensivesexual education for young people.However, HIV and SRH programmesstill remain largely vertical. Severalissues and challenges have contributedto this situation, including:Very little linkage between SRHand HIV services in Nepal at policyand system level except for HIVbeing included as part of the eightcomponents of RH in the NationalRH Strategy(1998) and inclusion ofHIV and AIDS as part of EssentialHealth Care Services in NHSP–IPsNo policy guidance for linkagebetween SRH and HIV fromMOHP.88