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

BANGLADESHCAMBODIANEPALPHILIPPINESon the provision of HIV-related clinicalservices, including VCT, management ofSTIs, antiretroviral therapy (ART) andtreatment for opportunistic infections.Steps have also been taken to improvethe safety of Bangladesh’s blood supplyby upgrading 19 hospitals and bloodbanks, training staff, supplying screeningkits, recruiting volunteer donors, andinstituting quality assurance. Goodprogress has been made in decreasingprofessional blood donations (that aremore likely to be infected) from 70 percent to 19 per cent of the supply, andincreasing voluntary donations from10 per cent to 31 per cent (20 years ofHIV, 2009).NGOs like FPAB, HASAB, AAS andMukto Akash who provide preventionand management of STIs services,also provide counselling on FP. VCTservices and psycho-social supportare also provided as part of generalcounselling through provider initiatedtesting and counselling. Condom,specific HIV information to FSWsand migrant labour are also part of theprovision of services.According to all respondents there isa shortage of equipment and of spacefor offering private and confidentialcounselling. Staff time and trainingis insufficient, and staff supervision ispoor. As a result, staff motivation is low,also due to a low pay scale in relationto work load. Some respondents werealso of the opinion that the linking ofSRH and HIV services has not hada major impact because they have notbeen well matched. No efficient serviceis available. Stigmatisation of servicesstill exists. Added to this is the workload and time of service providers.ObservationMost married women are vulnerableto HIV and other sexually transmittedinfections. This is attributed tohusbands who have unprotected sexwith sex workers, and continue to haveunprotected sex with their wives. Manybi-sexual men who have sex with mendo not necessarily identify themselves.Some men who buy sex from other menrarely use condoms and continue tohave sex with their wives. Men havingsex with men are largely hidden due tothe powerful stigma and discriminationthey face in society.Many people in both the rural andurban areas in Bangladesh have heardabout the HIV epidemic but theirknowledge is limited with regard tohow it is transmitted and how theycan protect themselves. Low condomuse, risky behaviour and a general lackof understanding about HIV are notlimited to clients of sex workers. Infact these traits are widespread andheighten the chances of a HIV epidemicin Bangladesh. The HIV prevalenceamong the general public is not fullyknown; currently available surveillancedata only covers high risk groups. Thisambiguity is partly because voluntaryand confidential counselling and testing(VCT) services are not widely availablein Bangladesh.A strong linkage between sexualand reproductive health services andHIV programmes in the countryis required to contain HIV andenhance the range of treatment, careand support. The successful linkagesbetween RH and HIV/AIDSprogrammes and services can only26