Back to Basics: HIV/AIDS Belongs with Sexual and Reproductive Health

As identified succinctly in its title, this article explores and challenges the fact that the issue of HIV has come to be diverted from sexual and reproductive health - and even from other sexually transmitted infections (STIs) - into a separate and often competing programme and funding stream. The authors trace the history of this divergence from the Programme of Action that was agreed upon at the 1994 International Conference on Population and Development (ICPD), the negotiators of which "knew that achieving universal access to sexual and reproductive health and protecting reproductive rights is necessary to achieve all the other goals, including the eradication of HIV/AIDS....15 years later....How did HIV/AIDS get separated from its base? What went wrong and how can it be fixed?"

The authors trace this history, explaining how factors such as the formation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the global launch of the Millennium Development Goals (MDGs) actually sharpened the deviation of HIV from sexual and reproductive health.

What can be done to restore the conceptual and organisational integrity of current approaches to sexual and reproductive health? The final section proposes the following 5 principles for priority setting:

• "First, renew or encourage new institutional commitments to achieving the Programme of Action of ICPD. At the heart of the ICPD consensus - and now a target of the MDGs - is universal access to sexual and reproductive health and the protection of human rights..."
• "Second, invest in health systems capacity building with priority attention to universally accessible comprehensive sexual and reproductive health services, especially at the primary level..."
• "Third, prioritize prevention programmes in schools, communities and health systems that provide information and counselling on the positive aspects of sexual and reproductive health as well as on how to avoid STIs/HIV, unwanted pregnancies, sexual coercion and gender-based violence, including special efforts to reach young people and marginalized groups..."
• "Fourth, assist countries to incorporate sexual and reproductive health and rights fully into their national, district and local-level HIV/AIDS control programmes and, conversely, to incorporate HIV prevention and treatment into all aspects of sexual and reproductive health information and services..."
• "Fifth, bilateral and multilateral donors have wide scope to amend their HIV/AIDS policies and budgets to invest in sexual and reproductive health and rights....Implementation remains a challenge, however, including fostering close working relationships and collaboration between previously separate staff and lines of work and achieving better balance between budgets for HIV/AIDS and the other components of sexual and reproductive health and rights."

In concluding, the authors stress that it is not enough to merely appeal for "collaboration", "bridging the gaps", and/or "strengthening linkages" between HIV/AIDS and sexual and reproductive health and rights. "What is needed is a reaffirmation of - and a greatly increased investment in - the conceptually and structurally coordinated ICPD approach to sexual and reproductive health and rights by United Nations agencies, donors, governments and nongovernmental organizations."