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

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In addition, not all services canbe provided through the <strong>HIV</strong>prevention programmes or <strong>SRH</strong>services separ<strong>at</strong>ely.Inadequ<strong>at</strong>e resources (personnel,funding, infrastructure) for theNASP, which is the governmentbody responsible for coordin<strong>at</strong>ingthe n<strong>at</strong>ional response to <strong>HIV</strong> inBangladesh, has prevented themfrom playing a more proactiverole in effective planning <strong>and</strong>coordin<strong>at</strong>ion <strong>at</strong> the n<strong>at</strong>ional level.This inadequacy has transl<strong>at</strong>ed intointerruptions in service delivery <strong>at</strong>the field level as well as inadequ<strong>at</strong>e,inappropri<strong>at</strong>e <strong>and</strong> irregular suppliesof m<strong>at</strong>erials (condoms, lubricants,sterile injection equipment, <strong>and</strong> STIdrugs).c. Programme PlanningGoB <strong>and</strong> NGOs identified highriskpopul<strong>at</strong>ion groups as keypriority <strong>and</strong> emphasised targetedinterventions for <strong>HIV</strong>/<strong>AIDS</strong>. Butthere is no baseline d<strong>at</strong>a to set targetsto acceler<strong>at</strong>e coverage.Lack of an integr<strong>at</strong>ed communitybased programme model th<strong>at</strong>will enhance social mobilis<strong>at</strong>ion<strong>and</strong> behaviour change, as well asempowerment of the community.Planning for sustained <strong>HIV</strong>prevention programmes is essentialfor an effective response. In order todo this, not only is it important tohave knowledge <strong>and</strong> underst<strong>and</strong>ingof the local situ<strong>at</strong>ion, but there alsoneeds to be capacity to developa str<strong>at</strong>egic plan based on th<strong>at</strong>knowledge.d. Implement<strong>at</strong>ion• Quality of the interventions variesconsiderably due to lack of initi<strong>at</strong>ivesfor strengthening <strong>and</strong> upgrading theskills of the implementing agencies.• Lack of a comprehensive packageapproach. All programmes aresingle minded approaches to <strong>HIV</strong>prevention, leading to partial deliveryof a fully responsive preventionpackage. For example, implementersoverlook multiple risks th<strong>at</strong> MARPsmay be facing. For IDUs, the stressis on safe injections, safe sex is oftenignored <strong>and</strong> condom distribution ispoor. For sex workers, drug use is notaddressed <strong>and</strong> neither is mobility.• The policies <strong>and</strong> str<strong>at</strong>egies, manuals,medical st<strong>and</strong>ards/SOPs, guidelinesth<strong>at</strong> are developed are the mainobstructions for linkage <strong>and</strong>implement<strong>at</strong>ion because they havea narrow focus <strong>and</strong> the aims aredifferent.e. Scaling upFunding of <strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> <strong>SRH</strong>is mostly project oriented r<strong>at</strong>herthan programme rel<strong>at</strong>ed. There isno comprehensive projection <strong>and</strong> noresource mobilis<strong>at</strong>ion plan for scaleupof responses.Evidence shows th<strong>at</strong> when the <strong>HIV</strong>prevention programmes were smallerthey were more effective. Scaling uphas possibly led to a dilution of theeffect of services in many cities; ithas also resulted in lower coveragethan in previous years.Scaling up has often been done using29

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