Memorandum submitted by the International
Planned Parenthood Federation (IPPF)
SUMMARY OF
RECOMMENDATIONS
1. IPPF recommends that existing SRH infrastructure
is used to deliver ARVs.
2. IPPF recommends that International Funding
Structures recognise the role that SRH organizations can play
in ARV delivery (in particular) and in health system strengthening.
3. IPPF recommends that there is greater control
over the quality of ARVs provided.
4. IPPF recommends that donors ensure there is
a continuous supply of ARVs.
5. IPPF recommends that all prevention and treatment
activities need to account for those who are HIV positive.
6. IPPF recommends that all prevention activities
need to be evidence based when targeting vulnerable populations.
7. IPPF recommends that ABC as a prevention strategy
is revised.
8. IPPF recommends that prevention and treatment
are seen as linked and mutually supporting activities.
BACKGROUND ON
THE INTERNATIONAL
PLANNED PARENTHOOD
FEDERATION
1.1 The International Planned Parenthood Federation
(IPPF) is a global network of 149 Member Associations working
in 183 countries and is the world's foremost voluntary, non-governmental
provider and advocate of sexual and reproductive health and rights.
1.2 IPPF aims to improve the quality of life
of individuals by campaigning for sexual and reproductive health
(SRH) and rights through advocacy and services, especially for
poor and vulnerable people. We defend the right of all young people
to enjoy their sexual lives free from ill-health, unwanted pregnancy,
violence and discrimination. We support a woman's right to choose
to terminate her pregnancy legally and safely. We strive to eliminate
sexually transmitted infections and reduce the spread and impact
of HIV/AIDS.
1.3 IPPF's strategy on HIV/AIDS aims to reduce
the global incidence of HIV/AIDS and to protect the rights of
those infected and affected. The four specific objectives towards
delivering this strategy are:
(i) to reduce social, religious, cultural, economic,
legal and political barriers that make people vulnerable to HIV/AIDS,
(ii) to increase access to interventions
for prevention of HIV/AIDS/STIs through integrated, gender-sensitive
and rights-based SRH programmes,
(iii) to increase access to care, support
and treatment for people infected and support for those affected
by HIV/AIDS, and
(iv) to strengthen the programmatic and policy
linkages between SRH and HIV/AIDS.
We therefore submit this Memorandum to highlight
issues and recommendations gained through our experience.
IPPF'S RESPONSE
TO THE
CALL FOR
EVIDENCE
Addressing the HIV/AIDS Pandemic: what are the
priorities in 2006?
2. The importance of the policy and programmatic
linkages between SRH and HIV/AIDS needs to be reflected in any
response to the HIV/AIDS pandemic. The majority of HIV infections
are sexually transmitted or associated with pregnancy, childbirth
and breastfeeding. The interactions between SRH and HIV/AIDS are
now widely recognised by the international community.[13]
In addition, sexual and reproductive ill-health and HIV/AIDS share
root causes, including poverty, gender inequality and social marginalization
of the most vulnerable populations. The international community
agrees that the Millennium Development Goals will not be achieved
without ensuring access to SRH services and an effective global
response to HIV/AIDS.
Issue: The delivery of ARVs in Resource-poor settings
IPPF recommendations:
3. Existing SRH Infrastructure.
3.1 Resource poor-settings frequently lack the
existing infrastructure to be able to deliver ARVs (both clinics
and staff) and a further consequence of being resource-poor is
that they are unable to build new infrastructure.
3.2 IPPF urges the UK government to support the
ARV capacity of SRH organisations. Many resource poor countries,
especially in Sub-Saharan Africa, already have an existing network
of Family Planning clinics and Associations (as part of the global
IPPF network) that provides an under-utilised resource capable
of providing ARV delivery. Current work by our IPPF Member Associations
in Kenya[14]
(the Family Planning Association of Kenya) and the Dominican Republic
(Associacion Dominicana Pro-Bienestar de la Familia) demonstrates
how this existing infrastructure and personnel can be used to
great effect in the delivery of ARV programmes within an SRH setting.
This forms part of wider recognition within the SRH
and HIV/AIDS communities about the benefits of integration of
SRH and HIV/AIDS policy and programmes.[15]
DFID documents recognise the importance of these linkages[16]
in tackling the HIV/AIDS epidemic and in supporting SRH services
generally.[17]
The UK government should apply this principle of linking SRH and
HIV/AIDS to delivering ARVs.
IPPF recommends that existing SRH infrastructure
is used to deliver ARVs
4. International Funding Structures.
4.1 International HIV/AIDS funding structures,
like the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM)
do not act on the linkages between SRH and HIV/AIDS. We recommend
making SRH issues a requirement of the GFATM funding proposals
would ensure stronger linkages between the two sectors.
Recent research by IPPF has highlighted the difficulties
our Member Associations (SRH clinics) face in becoming involved
in the country level bodies of the GFATM—because they are
seen by some as not "conventional" HIV/AIDS (ie organisations
that solely focus on HIV/AIDS or have been heavily associated
with HIV/AIDS in the past) organisations or as "competition".
4.2 IPPF urges the UK government to advocate
for the greater involvement of, and access to, SRH organisations
within international funding structures like the GFATM (This could
be through advocating for the inclusion of SRH as a requirement
(not a recommendation) for funding).
IPPF recommends that International Funding Structures
recognise the role that SRH organizations can play in ARV delivery
(in particular) and in health system strengthening
5. Quality of ARVS.
5.1 In some contexts governments are purchasing
supplies of ARVs based solely on cost considerations rather than
quality considerations. These concerns have been noted in Argentina,
Venezuela and Brazil. This can lead to ineffective drugs being
supplied to People Living With HIV/AIDS (PLWHA).
5.2 IPPF urges the UK government to advocate
for greater control over the quality of ARV drugs supplied in
resource-poor settings
IPPF recommends that there is greater control
over the quality of ARVs provided
6. A Continuous supply of ARVs.
6.1 Concerns have been expressed over the lack
of continuous supply of ARV drugs in some resource-poor settings.
Inadequate donor funding can lead to disruption of drug supply
to PLWHA—complicating treatment and leaving people without
proper care. This has been noted in Guatemala and Jamaica—where
lack of finance has led to ARV supply disruption.
6.2 IPPF urges the UK government to ensure there
are reliable and constant funding streams to ensure a continuous
supply of ARVs.
IPPF recommends that donors ensure there is
a continuous supply of ARVs
Issue: Prevention and treatment: achieving a balance
IPPF recommendations:
7. Accounting for those who are HIV Positive
7.1 Conventional prevention activities have usually
focused on the needs of HIV negative people, yet this ignores
the SRH needs and rights of PLWHA. Positive prevention refers
to a set of actions that help PLWHA protect their sexual health,
avoid other STIs, delay HIV/AIDS disease progression, and avoid
passing HIV infection to others.
7.2 IPPF urges the UK government to ensure that
all prevention and treatment activities include policy and programmatic
reference to the SRH needs and rights of PLWHA, and recognise
their crucial role in the epidemic.
IPPF recommends that all prevention and treatment
activities need to account for those who are HIV positive
8. Evidence based prevention activities.
8.1 Many prevention activities have focussed
on broad messages that do not account for the specific needs of
certain marginalized and vulnerable populations. These could,
in different regional and national settings, be Men who have Sex
with Men (MSM), Intravenous Drug Users (IDUs) and their partners,
or sex workers and their partners. Inappropriate prevention programmes
can mean those who most require services do not receive them.
IPPF recognises the UK government is promoting the need to support
vulnerable populations and rightfully raises the issues of affordability,
stigma and discrimination—all barriers to effective action,[18]yet
prevention and treatment programmes also need to be designed to
cater for the needs of marginalized and vulnerable populations.
8.2 Prevention and treatment programmes need
an evidence based approach to designing policies and programmes—vulnerable
populations have rights and specific needs that need to be addressed.
IPPF recommends that all prevention activities
need to be evidence based when targeting vulnerable populations.
9. Revision of ABC.
9.1 ABC—Abstain, Be Faithul, Use a Condom—has
been promoted by many agencies as a prevention strategy. However
as a strategy it does not provide universal protection. Many young
women and girls have no control over condom use or their age of
sexual debut, making abstinence for some an impossiblility. Marriage
is also not a protective factor for many—in some areas married
women are more likely to become infected than their unmarried
counterparts.[19]
Consequently, as a strategy, ABC is not protecting many young
women and girls.
9.2 IPPF urges the UK government to support efforts
to find an alternative message to ABC.
IPPF recommends that ABC as a prevention strategy
is revised.
10. Prevention and treatment are linked.
10.1 Prevention and treatment activities are
mutually beneficial—for example—treatment of STIs
acts to reduce vulnerability to HIV and therefore acts as a mode
of HIV prevention. This is further recognition of the linkages
between SRH and HIV/AIDS. The most efficient response would discuss
prevention and treatment in terms of links (and thus see them
as mutually supporting), instead of discussing them in terms of
"balance" (which would in some ways see prevention and
treatment as mutually exclusive).
10.2 Recognition of this synergy would lead to
a more efficient use of resources and greater levels of both prevention
and treatment. This refers again to the beneficial linkages between
SRH and HIV/AIDS.
IPPF recommends that prevention and treatment
are seen as linked and mutually supporting activities.
November 2005
13 The Glion Call to Action, The New York Call to
Commitment and A Framework for Priority Linkages (UNAIDS/UNFPA/WHO/IPPF-available
from www.ippf.org and see Appendix 1) (copy of Appendix 1 placed
in the Library). Back
14
An independently commissioned case study by the United Nations
Population Fund (UNFPA) has been written on the project run by
the Family Planning Association of Kenya (see Appendix 2-copy
of Appendix 2 placed in the Library). This highlights the
pioneering work being done by our Member Association in Kenya
in integrating SRH and HIV/AIDS services. Back
15
See "A Framework for Priority Linkages" (IPPF/UNAIDS/UNFPA/WHO,
November 2005) available from www.ippf.org-the document provides
a framework for key policy and programme actions to strengthen
the linkages between sexual and reproductive health and HIV/AIDS
programmes. Back
16
DFID, "Sexual and reproductive health and rights, a position
paper" (July, 2004), p 7 and UK Government "Taking Action,
The UK's strategy for tackling HIV and AIDS in the developing
world", p 43. Back
17
DFID, "Sexual and reproductive health and rights, a position
paper" (July 2004), p 17. Back
18
UK Government "Taking Action, The UK's strategy for tackling
HIV and AIDS in the developing world", p 48. Back
19
See Staneki, K (2002) The AIDS pandemic in the 21st Century.
Draft report. US Census Bureau, July 2002- http://www.dec.org/pdf
docs/PNACP816.pdf Back
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