SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...
SRH and HIV/AIDS Linkages at Policies, Programmes and Service ... SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...
BANGLADESHCAMBODIANEPALPHILIPPINESinequality, low level of engagementof men in responses to HIV relatedprogrammes, and HIV-related stigmaand discrimination. Legislations andpolicies, social and community attitudestowards key populations (e.g. MSM,SWs, IDUs, sexual minorities, migrants,refugees, displaced populations, youngpeople) are also addressed in the recentrevision.The National Youth Friendly HealthSurvey standard has been approvedand endorsed by the government underthe GFATM funded HIV/AIDSprogramme. Training manuals and thenational curriculum have also beenrevised.The National Standard OperatingProcedures (SOP) for IDUs, SWIsand PLHIV has been finalised by Savethe Children USA, and endorsed andpublished by the Government. TheseSOPs are now being applied to providethe respective services by NGOs andGoB funded programmes. There areseveral guidelines to assist doctorsand all persons providing services toPLHIV. However, there are no specificguidelines on SRH for women livingwith HIV.In Bangladesh, condoms are available formarried couples. The government has apolicy for procurement of condoms ona CYP (couple year protection) basis.CYP is the amount of contraceptionnecessary to protect one couple for oneyear [i.e. 100 male or female condoms,14 cycles of oral contraceptives, 0.5CycleBeads, 100 vaginal foaming tablets,.285 intrauterine devices, 4 injectables(3-month dose), 6 injectables (2-monthdose) or 12 injectables (1-month dose),0.1 voluntary sterilisations, 0.285implants and 13 doses of emergencycontraception].CYP is calculated by multiplying thequantity of each method distributedto clients by a conversion factor, toyield an estimate of the duration ofcontraceptive protection providedper unit of that method. The CYPsfor each method are then summed upfor all methods to obtain a total CYPfigure. CYP conversion factors arebased on how a method is used, failurerates, wastage and how many unitsof the method are typically neededto provide one year of contraceptiveprotection for a couple. The calculationtakes into account that some methods,like condoms and oral contraceptives,for example, may be used incorrectlyand then discarded, or that IUDs andimplants may be removed before theirlife span is realised. (See Annex 5 fordetails)Male condoms are distributed freeof charge to persons who seek healthservices in the local health centres;female condoms are only available insome pilot areas. The GFATM fundedHIV/AIDS programme has developeda strategy for young peoples’ access tocondoms, aimed at protection againstunintended pregnancy and STIs,including HIV. The strategy is awaitingGoB approval.There is no national guideline forroutine testing for HIV and syphilisamong pregnant women, although allhealth service sectors have facilitiesfor HIV testing. In Bangladesh thereis no legal age for HIV testing, neitheris it compulsory. Testing is done14
voluntarily, among project participantsparticularly the at-risk population.SRH documentation does not includeissues of HIV apart from some specialprogrammes for special groups ofpeople. CARE Bangladesh has createdpositive but not significant change forMSMs, SWs, IDUs and PLHIV. Thereis a need for more policy support fortheir right to health services, especiallyHIV services, and the reduction ofviolence.Within the broader HIV operationalplan, there are explicit activities toimprove access, coverage and qualityof SRH services to the generalpopulation, and target populations(e.g. MSM, SWs, IDUs, young peopleand PLHIV). At present the GoB isplanning to mainstream HIV, STI,and SRH services within all healthservices.The SOP makes clear reference toconfidentiality and disclosure for HIVrelatedservices. Confidentiality ismaintained for every case. Priority fordisclosure is at the total discretion of theclient. Some respondents reported thecontinued existence of discriminationwith regard to testing and support todisadvantaged groups (e.g. children,orphans, street children, and women),although the consent for HIV testingof adolescents is mentioned in thestrategy.In the National Youth Friendly HealthSurvey standard, training manuals andnational curriculum address the issuesrelated to HIV for minors and youth.Married, unmarried and minors haveaccess to VCT centres that are beingrun by different NGOs in the country,which helps to create opportunitiesfor knowledge disbursement amongthe MARP. “Youth Friendly HealthServices” and “Access to Condoms forYoung People in Bangladesh” in a senseis a stand-alone initiative. However theGoB may include it in the NationalHealth Policy or even in the NationalOperational plan.There are strong legislative and policyframeworks for effective action on bothHIV and SRH, and the promotion andprotection of sexual and reproductiverights. Laws related to issues thathave implications for HIV, AIDSand SRH (e.g. gender-based violenceand sexual coercion, discrimination,early marriage, widow inheritance)help officials to monitor human rightsviolations of MARPs. Civil societies,media, activists and professionalsregularly collect and share cases relatedto human rights violations. Networksof PLHIV and other groups (MARPs)also publish such cases regularly intheir newsletters, in an effort to movetowards a rights-based approach andensure equity of services. Nevertheless,the criminalisation of some riskbehaviours associated with HIVtransmission (sex work, illicit druguse) is impeding the implementation ofother HIV-supportive policies. Furthercoordination with law enforcementagencies and the criminal justice system,with strong support and commitmentfrom the highest levels of government,is still needed.Majority of respondents both from GOsand NGOs said that documentationshows that there are bi-directionallinkages between SRH and HIV15
- Page 2 and 3: Published by:International Council
- Page 5 and 6: Table ofContentChapter Titles Pages
- Page 7 and 8: INTRODUCTIONThe 2009 AIDS Epidemic
- Page 9 and 10: REVIEW OF LINKAGES BETWEEN SEXUAL A
- Page 11 and 12: ROUNDTABLE MEETING ON LINKAGES BETW
- Page 13 and 14: Mr Roberto M Ador, Executive Direct
- Page 15 and 16: Session 3: Health Systems Strengthe
- Page 17 and 18: Model for Public-Private Partnershi
- Page 19 and 20: CONCLUSIONSuccessful linkages betwe
- Page 21 and 22: INSTITUTIONALCAPACITY FORHIV/AIDS A
- Page 23 and 24: AbstractBackground: There are a num
- Page 25 and 26: the highest export earnings. The pr
- Page 27 and 28: grass-roots based service deliveryi
- Page 29 and 30: However, condom use was low amongho
- Page 31 and 32: 2and Save the Children, USA, and is
- Page 33: Many important national guidelines,
- Page 37 and 38: ut all sources have consistently sp
- Page 39 and 40: USA) and the World Bank ledconsorti
- Page 41 and 42: the Prevention of Parent to ChildTr
- Page 43 and 44: access to services for their consti
- Page 45 and 46: for planned prevention, treatment a
- Page 47 and 48: e accomplished if there is supporta
- Page 49 and 50: In addition, not all services canbe
- Page 51 and 52: daily lives and take priority overH
- Page 53 and 54: Promote the social acceptability of
- Page 55 and 56: References20 years of HIV in Bangla
- Page 57 and 58: 337
- Page 59 and 60: Annex 6: Figure 2: National AIDS Mo
- Page 61 and 62: INSTITUTIONALCAPACITY FORHIV/AIDS A
- Page 63 and 64: AbstractBackgroundThe HIV epidemic
- Page 65 and 66: NMCHCNRHPNSRSHNational Maternal Chi
- Page 67 and 68: management system, and health servi
- Page 69 and 70: universal access to HIV prevention,
- Page 71 and 72: In order to support the linked resp
- Page 73 and 74: ased violence, unplanned pregnancy/
- Page 75 and 76: The essential services package forr
- Page 77 and 78: care, and VCCT and ANC;Family plann
- Page 79 and 80: Strategy for RSH in Cambodia 2006 -
- Page 81 and 82: Logistics management proceduresfor
- Page 83 and 84: ReferencesStrategic Plan for HIV/AI
BANGLADESHCAMBODIANEPALPHILIPPINESinequality, low level of engagementof men in responses to <strong>HIV</strong> rel<strong>at</strong>edprogrammes, <strong>and</strong> <strong>HIV</strong>-rel<strong>at</strong>ed stigma<strong>and</strong> discrimin<strong>at</strong>ion. Legisl<strong>at</strong>ions <strong>and</strong>policies, social <strong>and</strong> community <strong>at</strong>titudestowards key popul<strong>at</strong>ions (e.g. MSM,SWs, IDUs, sexual minorities, migrants,refugees, displaced popul<strong>at</strong>ions, youngpeople) are also addressed in the recentrevision.The N<strong>at</strong>ional Youth Friendly HealthSurvey st<strong>and</strong>ard has been approved<strong>and</strong> endorsed by the government underthe GFATM funded <strong>HIV</strong>/<strong>AIDS</strong>programme. Training manuals <strong>and</strong> then<strong>at</strong>ional curriculum have also beenrevised.The N<strong>at</strong>ional St<strong>and</strong>ard Oper<strong>at</strong>ingProcedures (SOP) for IDUs, SWIs<strong>and</strong> PL<strong>HIV</strong> has been finalised by Savethe Children USA, <strong>and</strong> endorsed <strong>and</strong>published by the Government. TheseSOPs are now being applied to providethe respective services by NGOs <strong>and</strong>GoB funded programmes. There areseveral guidelines to assist doctors<strong>and</strong> all persons providing services toPL<strong>HIV</strong>. However, there are no specificguidelines on <strong>SRH</strong> for women livingwith <strong>HIV</strong>.In Bangladesh, condoms are available formarried couples. The government has apolicy for procurement of condoms ona CYP (couple year protection) basis.CYP is the amount of contraceptionnecessary to protect one couple for oneyear [i.e. 100 male or female condoms,14 cycles of oral contraceptives, 0.5CycleBeads, 100 vaginal foaming tablets,.285 intrauterine devices, 4 injectables(3-month dose), 6 injectables (2-monthdose) or 12 injectables (1-month dose),0.1 voluntary sterilis<strong>at</strong>ions, 0.285implants <strong>and</strong> 13 doses of emergencycontraception].CYP is calcul<strong>at</strong>ed by multiplying thequantity of each method distributedto clients by a conversion factor, toyield an estim<strong>at</strong>e of the dur<strong>at</strong>ion ofcontraceptive protection providedper unit of th<strong>at</strong> method. The CYPsfor each method are then summed upfor all methods to obtain a total CYPfigure. CYP conversion factors arebased on how a method is used, failurer<strong>at</strong>es, wastage <strong>and</strong> how many unitsof the method are typically neededto provide one year of contraceptiveprotection for a couple. The calcul<strong>at</strong>iontakes into account th<strong>at</strong> some methods,like condoms <strong>and</strong> oral contraceptives,for example, may be used incorrectly<strong>and</strong> then discarded, or th<strong>at</strong> IUDs <strong>and</strong>implants may be removed before theirlife span is realised. (See Annex 5 fordetails)Male condoms are distributed freeof charge to persons who seek healthservices in the local health centres;female condoms are only available insome pilot areas. The GFATM funded<strong>HIV</strong>/<strong>AIDS</strong> programme has developeda str<strong>at</strong>egy for young peoples’ access tocondoms, aimed <strong>at</strong> protection againstunintended pregnancy <strong>and</strong> STIs,including <strong>HIV</strong>. The str<strong>at</strong>egy is awaitingGoB approval.There is no n<strong>at</strong>ional guideline forroutine testing for <strong>HIV</strong> <strong>and</strong> syphilisamong pregnant women, although allhealth service sectors have facilitiesfor <strong>HIV</strong> testing. In Bangladesh thereis no legal age for <strong>HIV</strong> testing, neitheris it compulsory. Testing is done14
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