After just one day at the International AIDS Conference, it has already been an amazing experience. There is so much passion, energy, commitment, and determination here in Vienna that it would be impossible to walk away uninspired.

Today I have heard from so many experts on so many topics, that it is impossible to write about all of them, so I will focus on the session I attended titled, “The Global Context of Sexual and Reproductive Health and HIV: Making Seamless Programmes and Services a Reality for People Living with HIV.” The session focused on the integration of HIV and SRH services at the service delivery level and “linkages” at higher levels that are necessary for it to happen. Linkages are connections and coordination on a structural level between different sectors that are crucial to enable service delivery integration.

 

Although there has been notable effort to fund integrated programs, additional integration, linkages and coordination between donors is needed. Most countries have parallel departments in their ministries of health that address the various components of HIV, SRH, and other health needs. Linkages between these departments are essential to successfully integrate services, but to maximize effectiveness and comprehensiveness of care, it is necessary to take a rights-based approach, not just one that is health-based. Departments outside of the health sector can have significant implications on the delivery of care. 

 

It may be useful to build and strengthen linkages between health, policy, law enforcement, schools, and other sectors to reduce barriers to care and address a wide variety of patient needs. In addition, integrated services will be more effective with diverse and comprehensive support from a variety of departments within government, as well as the private sector. 

 

The session served to remind me not to forget the big picture and to consider all of the potential barriers to integrated services, as well as the opportunities.One useful tool for assessing linkages is called the “Rapid assessment tool for sexual and reproductive health and HIV linkages: A generic guide” (which can be found here). This tool was developed by several different private and public organizations, including IPPF, UNFPA, WHO, UNAIDS, and several others. The tool can be used to assess linkages between HIV and sexual and reproductive health at the policy, systems and service-delivery levels. It is intended to identify gaps and ultimately to contribute to the development of country-specific action plans to forge and strengthen these linkages. For additional tools for linking and integration HIV and SRH, please see www.hivandsrh.org. 

 

Do you think that linkages are necessary to successfully integrate services? Do you have any examples of countries or communities in which higher-level linkages enabled integration at the service deliver level? Do you have any suggestions of how to facilitate linkages between departments and sectors that are traditionally independent?