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

BANGLADESHCAMBODIANEPALPHILIPPINESBackgroundThe HIV epidemic became a keyreproductive and sexual health issuebecause the majority of HIV infectionsare sexually transmitted, or associatedwith pregnancy, and breastfeeding.According to the HSS report only1.1 per cent among pregnant womenattended ANC clincs. This indicatedthat the HIV/AIDS epidemic isbecoming generalised and familyplanning, safe motherhood, andprimary HIV prevention services inhealth centres are more critical for acomprehensive response between healthservices. According to the CDHS, only12.3 per cent of married women haveever been tested for HIV, with veryfew women being tested in the courseof ANC (12 per cent in 2005). Therisk of transmission from mother tochild remains high. Among womenwho tested HIV positive in the 2005CDHS, 2.2 per cent were pregnantat the time, and 35.9 per cent were inthe less than 24 months post-partumgroup. These figures recognise thatlinkages between reproductive healthand HIV are crucial to comprehensivemanagement and care for patients whoneed concomitant care for related healthconditions.The NCHADS is responsible for thehealth sector response to HIV/AIDSand sexually transmitted infection(STI) care and treatment, implementedat the operational district level througha continuum of care package andSTI control. Voluntary confidentialcounselling and testing (VCCT)and HIV testing among pregnantwomen are entry points for PMTCTservices and inpatient and outpatientcare for HIV/AIDS, together withopportunistic infections (OI) and antiretroviraltherapy (ART) services. Thecontinuum of care package also offerslinked services between health servicesand communities (HBC, Mondol MithChouy Mith (MMM), PLHASG)and HIV prevention with STI clinics.The CNMCHC is responsible forother reproductive health services,including ANC c , PMTCT, safedelivery, maternal and newborn health(MNBH), family planning (FP), andpostpartum care.The current health system in Cambodiaprovides access to HIV/AIDS, OI/ART, STI, ANC, FP and MNBH.However, these closely related servicesare often not available at the same healthfacility, and some operational districtsdo not offer the full package of services.As a result, the linkages betweenrelated health services are weak, aswell as those between health servicesand the community care services. Also,the linkage between SRH and HIV islimited and not directly linked to eachother. The linked response approachincluding PMTCT and other SRHprogrammes (ANC, FP, MNBH)hasbeen established and implemented bytwo national programs (NCHADSand NMCHC) to strengthen thecurrent health system, to improve thelinkages between health facilities andcommunity health services.This paper aims to assess the linkagesand integration of SRH and HIVservices at the health facility andcommunity services by an integratedpolicy and strategy, planning and46