Strengthening HIV and SRH Linkages - The World...

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Strengthening the Linkages Between Sexual and Reproductive Health and

HIV/AIDS in the World Bank’s Assistance Strategy:

A Preliminary Assessment

Usha VatsiaWorld Bank, HNP Unit, Human Development Network

July 8, 2008

Contents

Strengthening the Linkages Between Sexual and Reproductive Health and HIV/AIDS in the World Bank’s Assistance Strategy: A Preliminary Assessment

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1. Introduction.....................................................................................3Rapid literature search.............................................................................3Interviews with Bank staff........................................................................3Meetings with Interagency Partners........................................................3

2. The State of SRH and HIV Linkages................................................4International Commitment & Action............................................................4Global Funding.............................................................................................5Bank Efforts to Date.....................................................................................6

3. Potential opportunities to engage....................................................6External to the Bank....................................................................................6

Global Leadership.....................................................................................6Interagency Working Group.....................................................................7

Within the World Bank.................................................................................7HNP..........................................................................................................7Global HIV/AIDS Program........................................................................7The Regions..............................................................................................8

Annex 1. Rapid Literature Search........................................................9

Annex 2. Bank SRH-HIV/AIDS Linkages Experience Matrix..............16

Annex 3. Major Organizations Working on SRH-HIV Linkages.........21

Annex 4. FP-HIV Integration Interagency Working Group: Organizations and Experts.................................................................22

Annex 5. Family Planning/HIV Interagency Working Group, October 2008 Meeting.....................................................................................27

World Bank, HNP, Pop RH TeamJune 2008


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1. Introduction

This World Bank commissioned report (June 2008) is an assessment of the state of SRH and HIV/AIDS linkages with the objective of providing preliminary information and recommendations on which to base future Hub efforts on this initiative. Derived from a brief review of recently published and gray literature, key Bank staff interviews, and meetings with interagency partners between May 15 and June 25, 2008, this report summarizes the major findings and potential opportunities for the HNP Unit to strengthen and promote synergies between SRH and HIV/AIDS.

Rapid literature search

A rapid search of literature was conducted using Google Scholar and specific websites, i.e., www.HIVandSRH.org, WHO, for articles published since the 2006 international conference in Addis Ababa, Ethiopia, and documents shared by Bank staff.

60 documents were gathered through this search. Over a third of the documents relate to health systems strengthening and financing, and policy or advocacy, and almost a third relate to meeting the needs of specific demographic groups, i.e., youth, orphans and vulnerable children (OVC), and people living with HIV/AIDS (PLWHA). Thirteen of these documents relate to service integration, and three provide guidance or recommendations to specific organizations on integration. The needs of women and girls were noted to be a cross-cutting theme in many of these documents. The bulk of literature provided by Bank staff relate to HIV/AIDS program experience, two address SRH and HIV integration in strategy documents (HNP and ActAfrica), two are external interagency documents for activities which Bank staff provided technical input, and one report documents SRH/HIV linkages in three countries. The complete list of literature from this search can be found in Annex 1.

Interviews with Bank staff

Background meetings and interviews were conducted with available Bank staff in the Hub, the Global HIV/AIDS Program, and the Regions to gather relevant information for this assignment. Given the brevity of time and staff travel schedules, the interviews conducted in this short period were fewer than ideal. Nevertheless, the interviews conducted were informative. Some of the meetings yielded additional documents for review and are included in Annex 1, though most were not found to relate directly to SRH and HIV linkages. Annex 2 contains a matrix of the Bank’s experience captured in these interviews.

Meetings with Interagency Partners

Meetings were held with partners working on the Family Planning and HIV/AIDS Integration Interagency Working Group (IWG) to gather information on the group’s



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current agenda, primarily with USAID’s focal points and FHI. These meetings have been vital in gaining access to important information, such as the ongoing Cochrane review on SRH and HIV/AIDS linkages. The scope of the Hub’s rapid literature search, discussed earlier, was adapted as a result of this new information. In addition, HNP became a part of the IWG’s preparatory panels to review current evidence on which it will base its technical recommendations in an upcoming workshop in October described in detail in the next chapter.

2. The State of SRH and HIV LinkagesInternational Commitment & Action

The international community has evolved in its understanding of SRH and HIV linkages since the 1994 International Conference on Population and Development (ICPD), and in the last two years made a clear statement as the relevance and importance of linking HIV and SRH: for the good of the individuals most impacted—women, girls, and PLWHAS; and for the cost-effectiveness of programs.

In September 1994, the ICPD established that the effective prevention and treatment of sexually transmitted diseases, including HIV, is an integral part of reproductive health services.1

Almost ten years later, the Glion Call to Action in May 3-5, 20042, and the New York Call to Commitment on June 4, 20043 issued policy statements confirming the international community’s commitment to intensifying the linkages between SRH and HIV/AIDS.

In 2005, UNAIDS put forth a policy position paper, “Intensifying HIV Prevention”4 , which highlighted the urgency to scale up efforts to prevent HIV in order to reverse the epidemic by forging links with other programs and services including SRH since the majority of HIV infections are sexually transmitted or are associated with

1 WHO/HIV/2005.05: WHO/UNFPA/UNAIDS/IPPF. Sexual and Reproductive Health and HIV/AIDS: A Framework for Priority Linkages, October 2005. Available at: http://www.who.int/hiv/pub/prev_care/A%20Framework%20for%20Priority%20Linkages%20FINAL.pdf

2 WHO, The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children, May 3-5, 2004. Available at: http://www.who.int/reproductive-health/stis/docs/glion_cal_to_action.pdf

3UNFPA, The New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health, June 4, 2004 Meeting, Rockefeller Foundation, New York, NY, 2004. Available at: http://www.unfpa.org/upload/lib_pub_file/321_filename_New%20York%20Call%20to%20Commitment.pdf 4 UNAIDS, Intensifying HIV Prevention: A UNAIDS Position Paper, 2005. Available at: http://data.unaids.org/publications/irc-pub06/jc1165-intensif_hiv-newstyle_en.pdf


http://data.unaids.org/publications/irc-pub06/jc1165-intensif_hiv-newstyle_en.pdf

http://www.unfpa.org/upload/lib_pub_file/321_filename_New%20York%20Call%20to%20Commitment.pdf


http://www.who.int/reproductive-health/stis/docs/glion_cal_to_action.pdf

http://www.who.int/hiv/pub/prev_care/A%20Framework%20for%20Priority%20Linkages%20FINAL.pdf



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pregnancy, childbirth, and breastfeeding.5 Furthermore, the paper identifies some of the same common root causes, i.e., gender inequity, poverty, and social marginalization of the most vulnerable populations and groups. By strengthening links between HIV and SRH programs and services, and by putting special effort into reaching people excluded from access to health and other services, the paper asserts that the result would be more relevant, cost-effective, and impactful programs.

Since 2006, there have been two major international consultations to share the evidence on linking SRH and HIV to inform program and policy development in Africa and South Asia. There was also a landmark global consultation on SRH and Rights of PLWHA held in Amsterdam in December 2007 sponsored by EngenderHealth, IPPF, UNAIDS, UNFPA, and WHO. During this meeting, an international group of 65 HIV-positive women, men, young people, and transgender individuals articulated a vision statement to guide advocacy, policy, programs, and funding priorities that respect their basic SRH rights and wishes, emphasizing the need for health systems to do the same.6

In 2008, a Family Planning/HIV Interagency Working Group (IWG) has been actively working on building this evidence on integrating three specific service areas with family planning: counseling and testing, preventing mother to child transmission (PMTCT), and, care and treatment. This IWG will convene a workshop this coming October, to be chaired by WHO, where 50 FP and HIV technical experts from donors, NGOs, local governments, and PLWHAs will review what is known about FP/HIV integration, and develop technical recommendations for field programs integrating FP and HIV. To prepare for this meeting, technical expert panels have been formed to review the literature for each of the three intervention areas. The panels will draft technical recommendations to be considered, amended, and finalized at the October meeting. Annex 5 contains more information about this workshop and the literature reviews being conducted by the panels.

The upcoming August 2008 International AIDS Conference in Mexico City has included sessions and workshops which link SRH and HIV, such as addressing challenges for girls and women, in relation to SRH rights, PLWHAs, fertility, and Global Fund proposals, to name a few examples.

Global Funding

The current global health funding climate has led to heightened concerns that HIV/AIDS, and other disease-focused funding is eclipsing funding for other areas of health, including for sexual and reproductive health. As a major donor of HIV/AIDS programs, the USG’s funding limitations, ideologically rather than evidence-based, has crippled the ability of organizations to develop effective and appropriate responses to the epidemic on the ground. These funding patterns have weakened

5 WHO/HIV/2005.05, October 2005.

6 WHO, Landmark Global Consultation on Sexual and Reproductive Health and Rights of People Living with HIV, 2007. Available at: http://www.who.int/reproductive-health/hiv/jointannouncment_srh_plhiv.pdf


http://www.who.int/reproductive-health/hiv/jointannouncment_srh_plhiv.pdf


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healthcare infrastructure as a whole, as influenced by the movement of workers to better-resourced programs.

At the writing of this report, the proposed US budget is still expansive for HIV/AIDS and malaria initiatives. Counter to that expansion, the US commitment to core programs and services focused on women and children continue to lag without legitimate justification.7 Uncertainty in the global health funding environment remains, particularly in light of the upcoming US elections, the war-on-terror related commitments, and the troubled US economy.

The one bright light in this scenario appears to be the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) which recently accepted proposals that contain sexual and reproductive health and HIV/AIDS integration services.

Bank Efforts to Date

Efforts to integrate SRH and HIV/AIDS on Bank projects have been limited to date.

In the past year, Africa is the only region (Act Africa) that has been consciously building linkages experience, i.e., in Ethiopia, which it is in the process of finalizing its documentation of lessons learned. Several regions were not interviewed during this brief period (ECA, LAC, SAR), which might have missed integration related activities in those regions.

HNP recently completed documenting three country case studies from Malawi, Niger, and India. In May 2008, HNP joined the Family Planning (FP)/HIV Interagency Working Group (IWG) that is working on building the technical aspects of FP/HIV integration, and is serving on a counseling and testing technical panel which will be used in the October 2008 workshop mentioned earlier in this section.

7 Global Health Council, Analysis of the President’s FY09 Budget Request for Global Health, Public Policy Update, Global Health Link, April 2008 Issue #148.



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3. Potential opportunities to engage External to the BankGlobal Leadership

Given the growth in momentum and international consensus to link SRH and HIV/AIDS, the current funding environment and related complications of current USG policies, this is a critical time for the World Bank to take on a larger leadership role in filling the gaps that emerged in this analysis. In particular, it should consider focusing its efforts on promoting and building the evidence-base for:

the prevention agenda;

SRH rights of PLWHA, women, and girls8;

health systems strengthening for SRH-HIV integration (from policy level to community level service delivery)

In order to be effective in this global technical leadership role, the Hub would also need to galvanize colleagues in GHAP, including GAMET and ASAP, and in the Regions to develop and contribute to a common agenda to share its experience with the international community.

Interagency Working Group

There are several meetings in the next several months where HNP could continue making a significant contribution to the FP/HIV IWG, including: panels activities to review the literature and draft technical recommendations on FP and counseling and testing integration from July to September in Washington, DC and Mexico City during the International AIDS Conference (IAC); finalizing technical recommendations in October 21-22 workshop; and a follow-on donor’s meeting on October 23, the latter two of which will be held in Washington, DC.

HNP might consider continuing to contribute to the IWG in the future to share Bank experience with international partners working on this critical area. A complete list of people and organizations involved in the Family Planning/HIV IWG is contained in Annex 4.

8 Pursuing the needs of women and girls is not meant to imply that men and boys should be ignored as effective male engagement and participation is now recognized to be an essential strategy for empowering women and girls in improving their sexual and reproductive health.



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Within the World BankHNP

HNP may consider actively engaging all relevant teams within the Hub to ensure that the SRH-HIV/AIDS Linkages initiative is appropriately incorporated into current and future Hub activities, such as the health systems strengthening study. By the same token, it may explore how the initiative might be added into other PopRH projects to maximize the results of each work program.

Hub colleagues could be invited to attend presentations SRH and HIV integration, such as the August 20, 2008 meeting planned with FHI, to gain a better understanding of the importance of this area to the Hub’s work and to the progress made in international commitments in the HIV and SRH community.

Global HIV/AIDS Program

Before starting any integration work together, HNP might need to orient GHAP colleagues on SRH and its relationship to HIV/AIDS, and GHAP might be asked to brief the Hub on current related issues from its perspective. Doing so will help both teams better understand the rationale and benefits of integration.

As mentioned in the last Chapter, there is no apparent conscious effort to integrate SRH into HIV/AIDS programs. Nonetheless, when presented with the opportunity, there was expressed interest in GHAP in collaborating on cost-effectiveness studies and in developing practical tools.

Another potential area to partner is with the Global AIDS Monitoring and Evaluation Team (GAMET), which works closely with UNAIDS and other global partners such as other UN agencies, bilateral donors, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, is the identification, development, and testing of integration measures or indicators.

To facilitate related knowledge sharing and product development in the Bank, the Hub could form an Intraagency (World Bank) SRH/HIV/AIDS Linkages Working Group that could be formed as a sub-group of the PRH Thematic Group, to engage and build awareness on the importance of integrating SRH and HIV with GHAP and the Regions. This IWG could be initiated in partnership with GHAP to create a technical balance to the proposed working group. The SRH and HIV focal points could be invited to participate in this IWG and plan joint activities based on shared goals.

HNP might facilitate GHAP’s invitation to the FP/HIV/AIDS Integration Interagency Working Group (IWG) based on its expressed interest in joining this activity.

The Regions



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All but one of the regions interviewed report having no experience with integrated programs in their countries.

Africa is the only region (Act Africa) that has linkages experience, i.e., in Ethiopia, which it is in the process of finalizing its lessons learned; HNP could follow up to request a copy of this report and attend briefings on it, if any are planned. Although there was no need for technical assistance expressed at the time, the region might be asked if they have any needs that became more apparent as a result of their lessons learned from Ethiopia. ActAfrica is likely to develop knowledge products in the coming year, which might be an area for collaboration. It also plans to start attending the interagency working groups on integration, which it attended in the past. HNP is already collaborating with ActAfrica in inviting FHI to share lessons learned from its recently conducted five-country assessment in a meeting planned for August 20th this year.

East Asia and Pacific (EASHD) region assisted in developing a small communications piece for a SRH and HIV education project for the transport sector in China, and conducted a biobehavioral study in Papua, Indonesia. They have plans to conduct a behavioral survey in PNG. Although the region did not have any current technical assistance needs, it may in a couple of years to follow up to the work in Papua.

Middle East & North Africa (MENA) region has a possibility to develop an integrated health and HIV/AIDS program in Djibouti where there might be an opportunity to provide technical assistance. This region has no other current needs, but is more open to SRH than HIV due to the conservative nature of the societies in the countries in works with.

Most regions seemed not to completely understand SRH and how it might be integrated into HIV/AIDS. The Regions could be invited to join the PRH Thematic Group, which will be re-activated, to develop a common agenda on integration, i.e., building the technical knowledge within the Bank, share experience, and create practical tools.



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Annex 1. Rapid Literature Search

1. Adair, T, Desire for Children and Unmet Need for Contraception among HIV-Positive Women in Lesotho, DHS Working Papers, Macro International, Inc., March 2007.

2. Askew, I, Berer, M, The Contribution of Sexual and Reproductive Health Services to the Fight against HIV/AIDS: A Review, Reproductive Health Matters 2003; 11 (22):51-73. http://www.jstor.org/stable/pdfplus/3776046.pdf

3. Bates, N, Policy Updates: Significant Changes Expected for Global Health Programs Funding in FY 2007, Global Health Link, August-September 2006 Issue 140.

4. Bearinger, LH, Sieving, RE, Ferguson, J, Sharma, V. Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential, The Lancet, Vol. 369, April 7, 2007. http://conf2007.womendeliver.org/youth/pdf/9_global_Perspectives.pdf

5. Bell, E, Mthembu, P, O’Sullivan, S, Moody, K. Sexual and Reproductive Health Services and HIV Testing: Perspectives and Experiences of Women and Men Living with HIV and AIDS, Reproductive Health Matters, 2007. http://www.who.int/reproductive-health/hiv/rhmarticles/perspectives.pdf

6. Bell E; Perchal P, Sexual and reproductive health for HIV-positive women and adolescent girls: manual for trainers and programme managers, New York, New York, EngenderHealth, 2006. [235] p. http://www.engenderhealth.org/files/pubs/hiv-aids-stis/SRH_for_HIV_Positive_Women_English.pdf

7. Daly, M. F. Schechtman, L, SHADOW REPORT Review of Country Coordinating Mechanism Proposals with SRH-HIV/AIDS Integration Submitted to the Global Fund Round 7, Global AIDS Alliance, 24 August 2007.

8. Daulaire, N, Funding Must be Equitable, Letter from the President, Global Health Link, February-March 2007 Issue #143.

9. de Bruyn, M. Women, Reproductive Rights, and HIV/AIDS: Issues on Which Research and Interventions are Still Needed , Journal of Health, Population and Nutrition, Vol. 24, No. 4, Dec, 2006, pp. 413 – 425. http://www.bioline.org.br/request?hn06050


http://www.bioline.org.br/request?hn06050

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http://www.who.int/reproductive-health/hiv/rhmarticles/perspectives.pdf

http://conf2007.womendeliver.org/youth/pdf/9_global_Perspectives.pdf

http://www.jstor.org/stable/pdfplus/3776046.pdf


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10. Dickinson, Clare. Integration between sexual and reproductive health and HIV and AIDS and Malaria: opportunities and strategic options for the Global Fund to Fight AIDS, TB, and Malaria, Discussion Piece, November 2006. http://www.interactworldwide.org/objs/1168875845-global_fund_srh_integration_final.pdf

11. Druce, M, Dickinson, C, Attwell, K, Campbell White, C, A, Standing, H. Strengthening linkages for sexual and reproductive health, HIV and AIDS: progress, barriers and opportunities for scale-up: Final Report, DFID Health Resource Center, August 2006. http://www.dfidhealthrc.org/publications/HIV_SRH_strengthening_responses_06.pdf

12. Eber, M, Danielson, C, Partnerships in Reproductive Health Programming: US Foundations Filling the Gaps, Global HealthLink, April-May 2007, Issue #144.

13. Eber, M. Top Reseau: Integrated Youth Services in Madagascar, PSI, Interagency Youth Working Group Presentation, December 6, 2007. http://www.infoforhealth.org/youthwg/iywg/Integration_Eber.pdf

14. Edouard, L, Shaw, D, Access to sexual and reproductive health services: rights, priorities, commitments and actions, International Journal of Gynecology and Obstetrics (2007) 97, 227-228. www.elsevier.com

15. Farrell, BL, Family Planning-Integrated HIV Services: A Framework for Integrating Family Planning and Antiretroviral Therapy Services, The Acquire Project/USAID, June 2007. http://www.acquireproject.org/fileadmin/user_upload/ACQUIRE/Publications/FP-HIV-Integration_framework_final.pdf

16. Fathalla, Mahmoud F., Sinding, Steven, Rosenfield, Allan, Fathalla, Mohammed M.F.WHO, Sexual and reproductive Health for all: a call for action, The Lancet Sexual and Reproductive Health Series, October 2006. http://mosquito.who.org/reproductive-health/publications/articles/article6.pdf

17. Fazekas, K. Country Assessments: Documenting Family Planning-HIV Integration Programs, FHI, Interagency Youth Working Group Presentation, December 6, 2007. http://www.infoforhealth.org/youthwg/iywg/Integration_Fazekas.pdf

18. Feachem, R, Sabot, O, The Global Fund 2001-2006: A review of the evidence, Global Public Health, October 2007; 2(4): 325-341.


http://www.infoforhealth.org/youthwg/iywg/Integration_Fazekas.pdf

http://mosquito.who.org/reproductive-health/publications/articles/article6.pdf

http://www.acquireproject.org/fileadmin/user_upload/ACQUIRE/Publications/FP-HIV-Integration_framework_final.pdf

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http://www.infoforhealth.org/youthwg/iywg/Integration_Eber.pdf

http://www.dfidhealthrc.org/publications/HIV_SRH_strengthening_responses_06.pdf

http://www.dfidhealthrc.org/publications/HIV_SRH_strengthening_responses_06.pdf

http://www.interactworldwide.org/objs/1168875845-global_fund_srh_integration_final.pdf

http://www.interactworldwide.org/objs/1168875845-global_fund_srh_integration_final.pdf


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19. Fleischman, Janet. Integrating Reproductive Health and HIV/AIDS: Strategic Opportunities for PEPFAR, A Report of the CSIS Task Force on HIV/AIDS, July 2006. http://www.hivandsrh.org/iue_documents/4/docs/csishivaids.pdf?PHPSESSID=45770d7537f539750f092e19823e32a0

20. Fredrick, B, When the World Denies Its Women: Why Provide Universal Access to Reproductive Health Care, Global Health Link, August-September 2006 Issue 140.

21. Friedman, S, World Bank 10-Year Health Strategy Supports Family Planning and Sexual Reproductive Health, Global Health Link, June-July 2007 Issue #145.

22. FHI, Family Health Research Newsletter, Volume 1, Issue 1, CRTU/USAID, Research Triangle, NC, March 2007. http://www.fhi.org/NR/rdonlyres/ezk2qek52pa6ai2lbgex43gprvgh3iac7rzeyyd2qji2mgisksbkh7iufkrbq67cibr4laeejyet7o/EFHR11global1.pdf

23. Hainsworth, G. FP/HIV Integration and Youth: Insights from the Field, Pathfinder International, Interagency Youth Working Group Presentation, December 6, 2007. http://www.infoforhealth.org/youthwg/iywg/Integration_Hainsworth.pdf

24. Germain, A, Woods, Z. Women's Sexual and Reproductive Health and Rights: A key to ending HIV/AIDS, Development (2005) 48, 56–60. doi:10.1057/palgrave.development.1100194. http://www.palgrave-journals.com/development/journal/v48/n4/pdf/1100194a.pdf

25. Glasier, A, Metin Gulmezoglu, A, Schmid, GP, Garcia Moreno, C, Van Look, PFA. Sexual and reproductive health: a matter of life and death, The Lancet, November 1, 2006. http://medias.lemonde.fr/mmpub/edt/doc/20061102/830310_lancet.pdf

26. Global Health Council, Analysis of the President’s FY09 Budget Request for Global Health, Public Policy Update, Global Health Link, April 2008 Issue #148.

27. Görgens-Albino, M, Mohammad, N, Blankhart, D, Odutolu, O, The Africa Multi-country AIDS Program, 2000–2006: Results Of The World Bank’s Response To A Development Crisis , The Global AIDS Monitoring and Evaluation Team of the Global HIV/AIDS Program, World Bank, 2007.

28. Gregson, S. Nyamukapa, CA, Garnett, GP, Wambe, M, Lewis, JJC, Mason, PR, Chandiwana, SK, Anderson, RM. HIV Infection and reproductive health in


http://medias.lemonde.fr/mmpub/edt/doc/20061102/830310_lancet.pdf

http://www.palgrave-journals.com/development/journal/v48/n4/pdf/1100194a.pdf

http://www.palgrave-journals.com/development/journal/v48/n4/pdf/1100194a.pdf

http://www.infoforhealth.org/youthwg/iywg/Integration_Hainsworth.pdf

http://www.fhi.org/NR/rdonlyres/ezk2qek52pa6ai2lbgex43gprvgh3iac7rzeyyd2qji2mgisksbkh7iufkrbq67cibr4laeejyet7o/EFHR11global1.pdf

http://www.fhi.org/NR/rdonlyres/ezk2qek52pa6ai2lbgex43gprvgh3iac7rzeyyd2qji2mgisksbkh7iufkrbq67cibr4laeejyet7o/EFHR11global1.pdf

http://www.hivandsrh.org/iue_documents/4/docs/csishivaids.pdf?PHPSESSID=45770d7537f539750f092e19823e32a0

http://www.hivandsrh.org/iue_documents/4/docs/csishivaids.pdf?PHPSESSID=45770d7537f539750f092e19823e32a0


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teenage women orphaned and made vulnerable by AIDS in Zimbabwe, AIDS Care, October 2005; 17 (7):785-794.

29. Irmanigrum,YS, Priyono, JB, Syahboedin, I, Siahaan, T, Ruslam, IP, SutrisnaRisk, A, Behaviour and HIV Prevalence in Tanah Papua 2006: Results of the IBBS 2006 in Tanah Papua, Government of the Republic of Indonesia, Ministry of Health & Central Statistics Agency, April 2007.

30. Johns Hopkins Bloomberg School of Public Health and Constella Group, (funding provided by William and Flora Hewlett Foundation and the David and Lucile Packard Foundation), Resources for HIV/AIDS and Sexual and Reproductive Health Integration, n.d.http://www.hivandsrh.org/

31. JHSPH, Linking Reproductive Health, Family Planning, and HIV/AIDS in Africa: Conference Summary, Addis Ababa, Ethiopia, October 9-10, 2006. http://www.jhsph.edu/gatesinstitute/_pdf/policy_practice/FP-HIV/Presentations/Addis_ConfSum.pdf

32. Liljestrand J; Bryld J; Lazarus JV; Ostergaard LR, Synergizing HIV / AIDS and sexual and reproductive health and rights -- a manual for NGOs. 2nd edition, Copenhagen, Denmark, AIDSNET, the Danish NGO Network on AIDS and Development, 2006. 118 p. http://www.popline.org/docs/1700/303765.html (abstract) http://www.aidsnet.dk/Default.aspx?ID=3672 (ink to pdf) DID NOT PRINT – BIG DOC.

33. Mantell, JE, Harrison, A. Hoffman, S., Smit, JA, Stein, ZA, Exner, TM, The Mpondombili Project: Preventing HIV/AIDS among Rural South African School-Going Adolescents, Reproductive Health Matters 2006; 14 (28): 113-122. http://www.sciencedirect.com.libproxy-wb.imf.org/science?_ob=ArticleURL&_udi=B73FJ-4M9RGJC-F&_user=1916569&_coverDate=11%2F30%2F2006&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000055300&_version=1&_urlVersion=0&_userid=1916569&md5=b6b42b3adb25dda86a5cb271048490b2

34. McCarrarher, D. Integration of Contraceptive Counseling into HIV Services for Youth: Findings and Future Directions, FHI, Interagency Youth Working Group Presentation, December 6, 2007. http://www.infoforhealth.org/youthwg/iywg/Integration_McCarraher.pdf

35. Merkel J, Advocacy tool -- The sexual and reproductive rights and health of HIV positive women in South Africa, London, England, International Community of Women Living with HIV / AIDS, 2006. [32] p. http://www.popline.org/docs/1743/316369.html


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36. Ochieng, B. Erulkar, A. Integrating HIV & RH Services for Young People: The Friends of Youth (FOY) Program in Kenya, Population Council – Nairobi and Addis Ababa, http://www.infoforhealth.org/youthwg/iywg/Integration_Ochieng.pdf

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39. Raney, L, Financial Sustainability of Reproductive Health Care Services in Africa, Global Health Link, October-November 2006 Issue #141.

40. Reynolds, H, Wilcher, R, Best Kept Secrets in PMTCT: Contraception to Avert Unintended Pregnancies, AIDSLINK, Global Health Council, May/June 2006 #97. 2007

41. Segurado, AC, Paiva, V, Rights of HIV Positive People to Sexual and Reproductive Health: Parenthood, Reproductive Health Matters 2007; 15 (29 Supplement): 27-http://www.who.int/reproductive-health/hiv/rhmarticles/parenthood.pdf

42. Shire A, Ahmed S, de Bruyn M. Sexual and reproductive health of HIV positive women and adolescent girls: a dialogue on rights, policies and services. Global electronic forum. Report on results, New York, New York, United Nations Population Fund [UNFPA], March 2006. http://www.unfpa.org/upload/lib_pub_file/621_filename_e-forum_srh-hiv-positive-women.pdf

43. Stover, J, Fuchs, N, Halperin, D, Gibbons, A, Gillespie, D, Costs and Benefits of Adding Family Planning to Services to Prevent Mother-to-Child Transmission of HIV (PMTCT): How Family Planning can Increase the Benefits of PMTCT by saving lives and reducing the numbers of orphans, July 2003.

44. UNAIDS, Intensifying HIV Prevention: A UNAIDS Position Paper, 2005. Available at: http://data.unaids.org/publications/irc-pub06/jc1165-intensif_hiv-newstyle_en.pdf

45. UNFPA, The New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health, June 4, 2004 Meeting, Rockefeller Foundation, New York, NY, 2004. Available at:




http://www.unfpa.org/upload/lib_pub_file/621_filename_e-forum_srh-hiv-positive-women.pdf

http://www.unfpa.org/upload/lib_pub_file/621_filename_e-forum_srh-hiv-positive-women.pdf

http://www.who.int/reproductive-health/hiv/rhmarticles/parenthood.pdf

http://www.path.org/files/CP_india_convg_pol_update2.pdf

http://www.infoforhealth.org/youthwg/iywg/Integration_Ochieng.pdf


15


46. UNICEF/WHO, PMTCT High-Level Global Partners Forum Meeting Report, November 6-27, 2007.

47. USAID, Family Planning/HIV Integration: Technical Guidance for USAID-Supported Field Programs, 2003 http://www.usaid.gov/our_work/global_health/pop/publications/docs/fphiv.pdf

48. USAID, Meeting Agenda, Interagency Youth Working Group, December 6, 2007. http://www.infoforhealth.org/youthwg/iywg/6Dec07.shtml

49. WHO, The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children, May 3-5, 2004. Available at: http://www.who.int/reproductive-health/stis/docs/glion_cal_to_action.pdf

50. WHO/HIV/2005.05: WHO/UNFPA/UNAIDS/IPPF. Sexual and Reproductive Health and HIV/AIDS: A Framework for Priority Linkages, October 2005. Available at: http://www.who.int/hiv/pub/prev_care/A%20Framework%20for%20Priority%20Linkages%20FINAL.pdf

51. WHO, Guidance On Global Scale-Up Of The Prevention Of Mother To Child Transmission of HIV: Towards Universal Access For Women, Infants and Young Children and Eliminating HIV and AIDS Among Children, Inter-Agency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and Their Children, 2007.

52. WHO, Landmark Global Consultation on Sexual and Reproductive Health and Rights of People Living with HIV, 2007. Available at: http://www.who.int/reproductive-health/hiv/jointannouncment_srh_plhiv.pdf

53. WHO, Asia-Pacific Operational Framework for Linking HIV/STI Services with Reproductive, Adolescent, Maternal, Newborn and Child Health Services, March 2008. http://www.wpro.who.int/NR/rdonlyres/DB0EB0E3-3AB5-4667-ACD9-E8C5DAEA53FC/0/HSI_LinkingHIVServices_March2008_FINAL.pdf

54. Wittenberg J; Munthali A; Moore A; Zulu E; Madise N, Protecting the next generation in Malawi: new evidence on adolescent sexual and reproductive health needs, New York, New York, Guttmacher Institute, 2007. 48 p. http://www.guttmacher.org/pubs/2007/12/10/PNG_Malawi.pdf

55. World Bank, Health Development: The World Bank Strategy for Health, Nutrition, & Population Results, 2007.


http://www.guttmacher.org/pubs/2007/12/10/PNG_Malawi.pdf

http://www.wpro.who.int/NR/rdonlyres/DB0EB0E3-3AB5-4667-ACD9-E8C5DAEA53FC/0/HSI_LinkingHIVServices_March2008_FINAL.pdf

http://www.wpro.who.int/NR/rdonlyres/DB0EB0E3-3AB5-4667-ACD9-E8C5DAEA53FC/0/HSI_LinkingHIVServices_March2008_FINAL.pdf

http://www.who.int/reproductive-health/hiv/jointannouncment_srh_plhiv.pdf





http://www.infoforhealth.org/youthwg/iywg/6Dec07.shtml

http://www.usaid.gov/our_work/global_health/pop/publications/docs/fphiv.pdf




16

http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1154048816360/HNPStrategyFinalTextAnnexes.pdf

56. World Bank, Getting Results, Combating HIV in the East Asia and Pacific Region Transport Sector: Success on the Road in China East Asia and Pacific Region Transport Sector and Human Development, Global HIV/AIDS Program, November 2007.

57. World Bank, Getting Results, Risk Behavior and HIV Prevalence in Tanah Papua, Indonesia, Results of Integrated Biological and Behavioral Surveillance Among the General Population in Tanah Papua, Global HIV/AIDS Program, November 2007.

58. World Bank, HIV/AIDS Brief, East Asia and Pacific Region, Gray literature, World February 2008.

59. World Bank, The World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007-2011, March 2008. http://siteresources.worldbank.org/INTAFRREGTOPHIVAIDS/Resources/WB_HIV-AIDS-AFA_2007-2011_Advance_Copy.pdf

60. World Bank/HNP, HIV/AIDS and Sexual Reproductive Health Linkages: Case studies in Niger, Malawi, and one Indian State – Rajasthan, 2008.


http://siteresources.worldbank.org/INTAFRREGTOPHIVAIDS/Resources/WB_HIV-AIDS-AFA_2007-2011_Advance_Copy.pdf

http://siteresources.worldbank.org/INTAFRREGTOPHIVAIDS/Resources/WB_HIV-AIDS-AFA_2007-2011_Advance_Copy.pdf



Strengthening the Linkages Between Sexual and Reproductive Health and HIV/AIDS in the World Bank’s Assistance Strategy: A Preliminary Assessment 17

Annex 2. Bank SRH-HIV/AIDS Linkages Experience Matrix

Unit Experience/Plans Cost-effectiveness studies

Technical Assistance Needs Identified

Shared documents Other

GHAP – Robert Oelrichs

GHAP serves on an Interagency Task Team (IATT) for PMTCT.

GHAP has conducted a technical review mission in Cambodia with this group.

No experience with this on Bank projects.

No Private sector involvement in STI treatment (Cambodia)

2 documents shared: 1)PMTCT High-Level Global Partners Forum Meeting Report, Nov. 2007, and 2) WHO, Guidance on global scale-up of the prevention of mother to child transmission of HIV: towards universal access for women, infants and youngchildren and eliminating HIV and AIDS among children / Inter-Agency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers andtheir Children, 2007.

GHAP is interested in working on the FP-HIV Integration IWG and the Cochrane Review.

GHAP is also interested in collaborating on conducting studies or in developing toolkits for integration.

GHAP – Janet Leno, ASAP

No experience with this area on Bank projects.

------ ------ None Asked if IPPF and UNFPA is involved in the IWG

GHAP – GAMET, Marelize Gorgens-Albino

Overall comment based on experience with non-Bank work: There’s definitely recognition of the

They are looking at cost-effectiveness in China (David Wilson in GHAP is working on that).

Yes definitely so. She recommended the following three areas for technical assistance:

Marelize Görgens-Albino ... [et al.], The Africa Multi-country AIDS Program, 2000–2006 : results

World Bank, HNP, Pop RH Team June 2008





need to integrate. Maybe even go back to PHC approach instead of treating HIV as a separate disease. In the national response, there are some indicators for SRH as well as other areas on health.

In the Bank’s work: Might need to look at country specific documents to tease out this information.For instance, in Rwanda, MAP funds logistics, which supports the sector as a whole, not just HIV. None of the MAP countries seem to have specific SRH programs.

1. When we arrive at a policy, we must relate it to the other policies and not just leave it on its own.

2. There’s a need to link HIV and SRH information, not just the policies. For too long, HIV has been on its own.

3. At the field level, what’s needed is good practical advice. A publication series, not another set of guidelines, because there are too many already. Perhaps a set of case studies so there is knowledge sharing between countries and situations.

of the World Bank’s response to a development crisis , 2007.






ActAfrica, Africa (AFTHV) – Sangeeta Raja

In FY09, ActAfrica will likely take on the following integration activities: Compendium of

background resources, based on the paper Elizabeth wrote when she was in HNP

Knowledge management (based on FHI's work).

Participation in the Interagency group.

Other activities based on their lessons learned from Ethiopia.

----- --------- --------

East Asia and Pacific (EASHD) – Reem Hafez

HIV TTLs were canvassed to find none currently working no SRH and HIV integration. An internal regional brief on HIV was shared. The region’s primary focus on is on policy analysis/AAA and select lending.

------ ------ 4 documents shared: WB docs - Regional HIV brief, getting results docs on China and Papua, and Papua biobehavioural survey






The follow-up to the biobehavioral survey done in Papua, Indonesia, may lead to future work in this area but for now there is nothing planned.

The region developed a small journalistic piece (media) on SRH and HIV education in transport sector for China with Fei Deng.

There are plans for a behavioral study and lending in PNG in a couple of years.

Middle East & North Africa (MNSHD)Francisca Ayodeji Akala,

HIV is not a priority for the region.

Currently, it has one HIV project in Djibouti, and one study to gather information on prevalence rates on Lebanon amongst key groups through an IDF grant. Both projects will come to an end soon.

------- Not right now, perhaps by the end of the calendar year after the HIV synthesis is completed.

She sent a draft of the chapter on STI biomarkers they are using as proxies in this study (not for circulation).






In Yemen, there’s a health sector reform project that includes SRH.

In addition to the HIV project, there’s a health project in Djibouti, which is also coming to an end. There’s a possibility that the next health project will be proposed as a single project to include both health and HIV, which may lead be a potential opportunity to integrate HIV and SRH.

The region is conducting an HIV synthesis (through a consultant), who is exploring the use of biomarkers for other STIs as proxies, i.e., Herpes Simplex Virus Type 2, HPV and cervical cancer levels, with the hope that the biomarkers will yield useful data for talking to policymakers in the






region.



23

Annex 3. Major Organizations Working on SRH-HIV Linkages

The major organizations working on SRH and HIV Linkages include:

Centers for Disease Control (CDC) Elizabeth Glazer Pediatric AIDS Foundation (EGPAF) EngenderHealth Expanding Services Delivery Project, Management Sciences for Health,

Pathfinder (USAID) Family Health International (FHI) Global Health Fellows Program (GHFP) ICAP/Rwanda IPPF Johns Hopkins Johns Hopkins Bloomberg School of Public Health/Center for Communication

Programs (JHUCCP) Liverpool VCT/SA Pathfinder Population Council – Kenya, New York, South Africa Population Services International (PSI) United States Agency for International Development (USAID) World Bank World Health Organization (WHO) UNAIDS UNFPA University Research Co. (URC)



Annex 4. FP-HIV Integration Interagency Working Group: Organizations and ExpertsFP-HIV Integration Working GroupCounseling and Testing Panel Organizing CA: PSIPanel Facilitators: Dvora Joseph (PSI) and Alden Dillow (Pathfinder)USG Point Person(s): Alison Surdo, USAID/OHA and Stephanie Behel (CDC)

Last Name

First Name

Degrees

Title Department

Organization

Email Phone City

*Abeyta-Behnke

Mary Ann

Sr. Tech. Advisor

USAID [email protected]

202.712.5849 Washington

Adamchak

Susan PhD Scientist Health Services Res

FHI [email protected] 785.293.5197 Kansas

Axemo Pia Snr Health Spec (RH)

HDNHE/HNP

World Bank

[email protected] 202.473.2555 Washington

Askew Ian Sr. Associate Reproductive Health

Pop Council

[email protected] 254.20.27.1.3480

Nairobi, Kenya

Bradley Heather Johns Hopkins

[email protected] 202.258.2722 Baltimore

Behel Stephanie

MPH Epidemiologist Global AIDS Prog

CDC [email protected] 404.639.4700 Altanta

Chowdhury

Sadia MD, MPH

Sr. Health Specialist

Reprod Child Health

World Bank

[email protected]

Washington

Dillow Alden MPH HIV/AIDS Advisor

Techn Serv's Unit

Pathfinder [email protected] 617.924.7200 x206

Boston

Gillespie Duff PhD Prof and Sr. Scholar

Johns Hopkins


Grant April MPA Intern Office HIV/AIDS

USAID [email protected] 202-712-5602 Washington

Higgins Donna Technical Officer

WHO [email protected] 41.22.791.4557 Geneva

Janowitz Barbara PhD Director Health Services

FHI [email protected] 919.544.7040 Durham, NC


mailto:[email protected]















FP-HIV Integration Working GroupCounseling and Testing Panel Organizing CA: PSIPanel Facilitators: Dvora Joseph (PSI) and Alden Dillow (Pathfinder)USG Point Person(s): Alison Surdo, USAID/OHA and Stephanie Behel (CDC)

Last Name

First Name

Degrees

Title Department

Organization

Email Phone City

ResJoseph Dvora MPH Acting Director HIV

DepartmentPSI [email protected] 202.572.4645 Washington

Karklins Sabrina MPA Snr Rsrch Prog Coord

Pop/Fam/RH-BMGI

Johns Hopkins


Lamprecht

Virginia MPH, MA

Sr. Technical Adv.

Office of PRH

USAID [email protected] 202.712.0146 Washington

Liambila Wilson MSc Program Officer Com Health Population Council

[email protected]

254.2.2713480.83

Menziwa Mantshi MPH Sr. Program Officer

Reprod Health

Population Council

[email protected]

27.11.781.7590/7594

South Africa

*Neuse Margaret

MPH Consultant NA GHFP [email protected] 202.237.8934 Washington

Obichere Uchechi MSc Program Officer RH/FP ESD (MSH)

[email protected] 202.775.1977 x309

Washington

Prosser Wendy Technical Advisor

PSI [email protected] Mozambique

Surdo Alison MPH Sr. CT Advisor Office HIV/AIDS


Todd Alex Office of PRH


Vatsia Usha Consultant HDNHE World Bank

[email protected] 301.580.8015 Washington

Wekesa Paul MD,MBA

Ag Dir. of Services

NA Liverpool VCT/SA

[email protected]

254.20.2714590 Kenya

Weis Peter MD, MSc

Medical Officer ADGO/FCH WHO [email protected] 41.22.791.2965 Geneva

Yacobson Irina FHI [email protected] 919.544.7040 x431

Durham, NC

*Intermittent status



















FP-HIV Integration Working GroupPrevention of Mother-to-Child Transmission Organizing CA: Pathfinder (ESD Project)Panel Facilitators: Godfrey Sikipa (ESD (MSH) and Tabitha Sripipatana (EGPAF)USG Point Person(s): Glenn Post (USAID/GH/OHA); Nathan Shaffer (CDC) Last Name First

NameOrganization

Email Phone Degrees

Title Department

City

Abeyta-Behnke

Mary Ann

USAID [email protected]

202.712.5849 Sr. Tech. Advisor

GH/PRH/SDI

Washington

Flanagan Elizabeth EGPAF [email protected] 202.448.8412 Washington

Jacobs Troy USAID [email protected] 202.712.2847 MD GHF Tech Advisor

GH/HIDN Washington

Israel Ellen Pathfinder [email protected] 617.924.7200 x 277

Boston

Lamprecht Virginia USAID [email protected] 202.712.0146 MPH, MA

Sr. Tech. Advisor

GH/PRH/SDI

Washington

Lusti-Narasimhan

Manjula WHO [email protected]

41.22.791.1414 Geneva

Neuse Margaret

GHFP Consultant

[email protected] Washington

Norton Maureen USAID [email protected] 202.712-1334 GH/PRH/SDI

Washington

Perchal Paul EngenderHealth

[email protected]

212.993.9831 New York

Post Glenn USAID [email protected] PMTCT Peds GH/OHA Washington

Post May ESD (Pathfinder)

[email protected] 202.544.1977 x231

Washington

Rivero Estela Population Council

[email protected]

Shaffer Nathan CDC [email protected] AtlantaSikipa Godfrey ESD (MSH) [email protected] 202-775-1977

Ext 251 Technical

Director Washingto

nSripipatana Tabitha EGPAF [email protected] 310.491.3129 Washingto

nTsague Landry ICAP Rwanda [email protected] Kigali,

Rwanda






















FP-HIV Integration Working GroupPrevention of Mother-to-Child Transmission Organizing CA: Pathfinder (ESD Project)Panel Facilitators: Godfrey Sikipa (ESD (MSH) and Tabitha Sripipatana (EGPAF)USG Point Person(s): Glenn Post (USAID/GH/OHA); Nathan Shaffer (CDC) Last Name First

NameOrganization

Email Phone Degrees

Title Department

City

Warren Charlotte

Population Council

[email protected] 254 20 2713480/1

RH Associate Nairobi

Weiss Deborah Population Council

[email protected] 212.339.0694 New York

FP-HIV Integration Working GroupCare and Treatment (including ART and Home-based Care) Organizing CA: FHIPanel Facilitators: Rose Wilcher (main contact, FHI), Susan Adamchak (FHI) and Heidi Reynolds (FHI)USG Point Person: TBD (USAID Point Person) and Pam Bachanas (CDC)

Last Name

First Name

Organization

Email Phone Degrees

Title Department City

Abeyta-Behnke

Mary Ann

USAID [email protected] 202.712.5849

MPH Sr. Tech. Advisor

Washington

Adamchak Susan FHI [email protected] 785.293.5197

PhD Scientist Applied Research

Kansas

Bachanas Pamela CDC [email protected] 404.639.8110

PhD TL HIV Prev Ind/Fam

Global AIDS Prgm

Atlanta

Curtis Kate CDC [email protected] AtlantaDillow Alden Pathfinder [email protected] 617.924.72

00 x206MPH HIV/AIDS

AdvisorTechnical Services Unit

Boston

Farrell Betty EngenderHealth

[email protected]

212.561.8035

New York

Flanagan Elizabeth

EGPAF [email protected] 202.448.8412

Sr. Tech. Officer

Prev. Care and Tx. Ser.

Washington

Jamieson Denise CDC [email protected] AtlantaJohnson Sarah WHO [email protected] 41.22.791.3

967 Geneva

Lamprecht Virginia USAID [email protected] 202.712.01 Sr Tech GH/PRH/SDI Washingt















FP-HIV Integration Working GroupCare and Treatment (including ART and Home-based Care) Organizing CA: FHIPanel Facilitators: Rose Wilcher (main contact, FHI), Susan Adamchak (FHI) and Heidi Reynolds (FHI)USG Point Person: TBD (USAID Point Person) and Pam Bachanas (CDC)

Last Name

First Name

Organization

Email Phone Degrees

Title Department City

46 Advisor onLivesley Nigel URC [email protected] 301.941.85

57 Washingt

onO'Reilly Kevin WHO [email protected] GenevaNeuse Margar

etGHFP [email protected] Consultant Washingt

onReynolds Heidi FHI [email protected] 919.544.70

40 x510 PhD Scientist Applied

ResearchDurham, NC

Rinehart Ward JHUCCP [email protected] BaltimoreRosenburg Nora CDC AtlantaSikipa Godfrey ESD [email protected] 202.775.19

77 x251 Washingt

onSubramanian

Laura EngenderHealth

[email protected]

Geneva

Wilcher Rose FHI [email protected] 919.544.7040 x406

MPH Sr Prog Officer

Applied Research

Durham, NC












30

Annex 5. Family Planning/HIV Interagency Working Group, October 2008 Meeting

Concept Paper FP/HIV Integration Working Group

Technical Workshop

The FP/HIV Interagency Working Group (IWG) will convene a workshop October 21-22, 2008 in Washington, DC that will focus on the technical aspects of FP/HIV integration. The workshop will be sponsored by USAID and WHO will chair the meeting.

Purpose and ObjectivesThe overall purpose of the workshop will be to review promising integration models and practices and the circumstances in which integrated programs can achieve both family planning and HIV/AIDS public health objectives. The objectives of the workshop will be to:

1. Review what is known to date about FP/HIV integration, 2. Discuss and confirm draft technical recommendations for field programs

integrating FP and HIV developed by expert panels.

Preparation for the WorkshopPrior to the workshop, three expert panels will review FP and HIV research studies and the results of programmatic experiences, including new expanded Cochrane review as well as in-depth country assessments by FHI. The panels, who will meet periodically over the summer via teleconference, will analyze and synthesize the knowledge relating to the integration of FP and HIV services in the areas of 1) testing and counseling, 2) prevention of mother-to-child transmission, and 3) care and treatment, including anti-retroviral treatment and home-based care. Each panel will draft technical recommendations relevant to field programs, indicating how integration can best be achieved and under what circumstances it makes the most sense to support integrated FP/HIV programs. The panels will also identify gaps in knowledge about integration that can be addressed by future research.

Panel members will consist of experts in FP/HIV integration, including both researchers and program implementers directly involved with FP/HIV efforts in the field, as well as representatives and observers from major donors (including USAID, CDC, WHO, UNAIDS, etc), NGOs, and persons living with HIV/AIDS. It is anticipated that each panel will consist of about 12-15 persons each.



31

Workshop ParticipantsParticipants in the workshop in October will include panel members as well as high level technical experts, observers and government officials. About 50 persons are expected to attend the workshop.

Workshop ActivitiesDuring the workshop, researchers involved in current reviews of the literature and programmatic experience will summarize their findings, panels will present an overview of their discussions and draft technical recommendations, and workshop participants will confirm, or amend, the technical recommendations drafted by the panels prior to the workshop.

Main Outcomes of the WorkshopThe main outcome of the meeting will be a set of annotated technical recommendations informed by the latest evidence and programmatic experience, and will highlight under what circumstances FP/HIV integration is recommended. It is anticipated that the October workshop will inform future IWG meetings.



32

FP/HIV Interagency Working GroupTechnical Workshop

Overview and Instructions for Panel Members

I. Overview of the Expert Technical Panels and the Workshop

The FP/HIV Interagency Working Group (IWG) will convene a workshop October 21-22, 2008 at the Washington Club that will focus on the technical aspects of FP/HIV integration. The overall purpose of the workshop will be to clarify promising integration models and practices and the circumstances in which integrated programs can achieve both family planning and HIV/AIDS public health objectives. The specific objectives of the workshop will be to:

1. Review what is known to date about FP/HIV integration, and 2. Discuss and confirm draft technical recommendations for field programs

integrating FP and HIV developed by expert panels.

The workshop will be chaired by the World Health Organization (WHO).

Prior to the workshop, three expert panels will review research studies and the results of programmatic experiences addressing FP and HIV integration, including new expanded Cochrane review as well as in-depth country assessments by FHI. The panels will meet periodically over the summer via teleconference and will analyze and synthesize the knowledge relating to the integration of FP and HIV services in the areas of 1) testing and counseling, 2) prevention of mother-to-child transmission, and 3) care and treatment, including anti-retroviral treatment and home-based care. Panel members will consist of experts in FP/HIV integration, including both researchers and program implementers directly involved with FP/HIV efforts in the field, as well as representatives and observers from major donors (including USAID, CDC, WHO, UNAIDS, etc), NGOs, and persons living with HIV/AIDS. It is anticipated that each panel will consist of about 12-15 persons each.

Each panel will draft technical recommendations relevant to field programs, indicating how integration can best be achieved and under what circumstances it makes the most sense to support integrated FP/HIV programs. The panels will identify what approaches to integration and models of integration are likely to work, taking into consideration the programmatic context, including the directionality of the integration efforts as well as the specific services being integrated, the effects on FP and HIV programming, the challenges and barriers to integration, the policy environment and funding for both family planning and HIV/AIDS and integrated programs. The panels will also identify gaps in knowledge about integration that can be addressed by future research.



33

Workshop ParticipantsParticipants in the workshop in October will include panel members as well as high level technical experts, representatives from donors, NGOs, and local governments, as well as those living with HIV/AIDS. About 50 persons are expected to attend the workshop.

Workshop ActivitiesDuring the workshop, researchers involved in current reviews of the literature and programmatic experience will summarize their research findings, panels will present an overview of their discussions and draft technical recommendations, and workshop participants will confirm, or amend, the technical recommendations drafted by the panels prior to the workshop.

Outcomes of the WorkshopThe main output of the meeting will be a set of technical recommendations relevant to field programs attempting to integrate FP and HIV services. The technical recommendations will be informed by the latest evidence and programmatic experience.

II. Specific Information for Panel Members

1. Description of the Panels

The three panels are described here and will cover the following topics:

A. Family Planning and Counseling and Testing (FP/CT). This includes programs that have been implemented at the facility and/or community level designed to identify 1) counseling and HIV testing clients with unmet family planning needs and to link them with family planning methods via onsite choice and provision or referral, or 2) family planning clients with a need for HIV testing to link them with HIV testing via onsite provision or referral.

B. Family Planning and Prevention of Mother-to-Child Transmission (FP/PMTCT). This includes programs that have been implemented at the facility and/or community level designed to identify HIV+ antenatal care clients and HIV+ postpartum clients who will have a desire to use family planning or have a current unmet need for family planning and to link them with family planning methods via onsite choice and provision or via a referral.

C. Family Planning and Care and Treatment (FP/C&Tx). This includes anti-retroviral therapy and home-based care (FP/CTx) includes programs that have been implemented at the facility and/or community level designed to bring family planning methods or referrals to people living with HIV and AIDS to health facilities or home-based care in the community.



34

2. Panel Member Roles and Responsibilities

Each panel will be asked to complete the following tasks prior to September 12, 2008 as preparation for the October meeting:

Task 1: Review the literature

Panel members will review key articles and documents—including research results due to be released this year—identified by the panel facilitators in collaboration with the panel members. Panel members will read, analyze, and extract relevant information from the articles and documents with the aim of identifying how integration can best be achieved and under what circumstances it makes the most sense to support integrated programs. The panels will identify what approaches to integration and models of integration are likely to work, taking into consideration the programmatic context, including the directionality of the integration efforts as well as the specific services being integrated, the effects on FP and HIV programming, the challenges and barriers to integration, the policy environment and funding for both family planning and HIV/AIDS and integrated programs. The panels will also identify gaps in knowledge about integration that can be addressed by future research.

Relevant articles and documents may be found from the following sources: The expanded Cochrane1 Review, being prepared by researchers from Johns

Hopkins and the University of California at San Francisco; Country Assessments of FP/HIV integration being conducted in select PEPFAR

focus countries being prepared by Family Health International (FHI); Documents found on the www.hivandsrh.org website (which includes sources

listed on the Zoomerang survey (see below), as well as other published articles; Bibliographical reviews prepared by USG (United States Government) or other

partner cooperating agencies; and the ‘Gray’ literature



35

FHI is preparing a consolidated reference list that will be made available to the panels and will include many of the relevant documents used in the Cochrane Review and that

are on the website.

Task 2: Actively participate in discussion via teleconferences

Panel members will participate in a series of teleconferences over the summer to discuss articles, programs and issues relating to FP/HIV integration. It is anticipated that each panel will meet about four or five times between June and September.

Task 3: Help draft programmatic recommendations

Based upon the discussions, each panel will draft recommendations relevant to field programs. The draft recommendations are to be ready by September 12, 2008.

Task 4: Attend the October workshop and work to confirm or amend draft technical recommendations

Panel members will be invited to the IWG workshop in October, where they will participate in discussions relating to FP/HIV integration and work with other panels and workshop participants to confirm (or amend) the draft recommendations.

1 Cochrane methodology for searching the published literature and was included in the systematic review section of the report if it met the following criteria: (1) Published in a peer-reviewed journal between January 1, 1990 and March 17, 2007. (2) Presented post-intervention evaluation data of an SRH-HIV linkage intervention. (3) Used a pre-post or multi-arm comparison of individuals or communities who received the intervention versus those who did not to assess quantitative outcomes of interest.

Articles that did not meet the rigorous study design criteria of the systematic review were included in a review of “promising practices” if they met the following criteria: (1) Published between January 1, 1990 and December 31, 2007, or if publication date was unclear, presented data on a program that was ongoing after January 1, 1990. (2) Presented evaluation data from an


A Zoomerang survey has been distributed by email to panel members and others who have participated in FP/HIV integration meetings in Washington. The purpose of the survey is to identify the most important documents related to FP/HIV integration as identified by the FP-HIV integration community. When survey results are available, panel members will review the final list of the top 20 documents most frequently selected for their technical focus areas and confirm (or make suggestions for substitutions) the probable usefulness of the documents for the broader community of stakeholders involved in FP/HIV integration. The final list selected by each of the three panels will be used as a resource to the global health community and will be posted on the WHO Implementing Best Practices Initiative (IBP) website and distributed widely.


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SRH-HIV linkage intervention. (“Evaluation data” is considered to any information that helps determine whether the intervention was successful or not. This included quantitative and qualitative data and process or outcome data. Program summaries and lessons learned as reported by program implementers were also included) (3) Program/project was implemented in a low- or middle-income country, as categorized by the World Bank.



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Process for the CT Panel in Preparing for the October 21-22 Technical Workshop for the FP/HIV Integration Working Group

Proposed Timeline

June - Tuesday, June 24, 2:30 pm EST- Panel conference call/meeting to discuss the

steps forward with the review- All assignments will be distributed to panel members for review

July - Monday, July 14- all inputs/recommendations should be submitted via the

form available on the Zoho website- Findings from the Cochrane review discussed- End of July- Inputs/recommendations will be reviewed by Panel facilitators- Week of July 28- Conference call/meeting to be scheduled for all Panel

members to discuss overarching perspectives and different iterations.

August- Aug 3-6: International AIDS Conference in Mexico City—identify any

additional best practices- Monday, August 18- Draft Technical Recommendations will be sent out to the

Panel for feedback/comments

Early September- Finish draft Technical Recommendations and send to USAID contacts (Mary

Ann Abeyta-Behnke and Virginia Lamprecht) by September 12

Mid September- Draft Technical Recommendations will be reviewed for clarity,

comprehension, etc. at USAID and WHO

October - Workshop- October 21-22


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