Manjula Lusti-Narasimhan¹; Paul Van Look

Department of Reproductive Health and Research, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland

Since the first cases of HIV infection were reported almost three decades ago, several initiatives and agencies, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund to fight AIDS, Tuberculosis and Malaria, and the President's Emergency Plan for AIDS Relief, have been set up to deal with what has become an epidemic. It is estimated that in developing countries alone almost US$ 10 billion have been invested to fight the HIV epidemic.¹

Much of this financing has been targeted at providing antiretroviral therapy (ART) and this is showing results. At the end of 2007, nearly 3 million people (about 31% of those in need) were receiving ARTs in low- and middle-income countries.² However, when we ask ourselves what more could be done, it becomes strikingly apparent that efforts to prevent HIV infection have fallen behind those put into HIV treatment and care. In this aspect, promoting sexual and reproductive health is an important strategy to ensure that people have the knowledge and ability to protect themselves not only against unintended pregnancies but also, importantly, against sexually transmitted infections, including HIV. Moreover, with the availability of ARTs, people infected with HIV are living longer, healthier lives, resulting in the need to provide them with better services that meet their sexual and reproductive health needs and respect their rights.

A Bulletin theme issue on strengthening the linkages between sexual and reproductive health and HIV will explore some of the reasons why the public health community needs to bridge the gaps that exist between these two critical aspects of public health. It will include the latest research and best practices in this area, but also explore how these linkages permeate and are relevant to issues such as environment and poverty. Its overall objective is twofold: to raise awareness about the importance of collaboration between the sexual and reproductive health and HIV constituencies; and to highlight successful interventions and policies that can enable the attainment of internationally agreed goals and targets.

International commitments and policies have increasingly emphasized the need for universal access to HIV prevention, treatment, care and support as well as universal access to sexual and reproductive health. Scaling-up effective and comprehensive services that address sexual and reproductive health needs, including HIV testing, treatment, care and support, is therefore among the most cost-effective and efficient means of attaining such universal access.³

The public health community can help build cost-effective and sustainable national health-care systems by avoiding missed opportunities resulting from inadequate linkages between sexual and reproductive health and HIV. For example, even in countries where health systems are weak, as many as 70% of pregnant women⁴ manage to attend at least one antenatal care visit, but only about 11% currently gain access to HIV testing and counselling and ART prophylaxis interventions during pregnancy and childbirth.⁵

The rationale for strengthening linkages between sexual and reproductive health and HIV is that both fields directly concern men, women and young people who are sexually active. The success of policies and programmes related to either sexual and reproductive health or HIV is directly linked to how we tackle the key issues and determine priority interventions. For example, side-stepping issues related to unsafe sex, for political, cultural, financial or other reasons, only aggravates the public health challenges and hampers progress. More than 80% of HIV infections are sexually transmitted⁶ and, every year, unsafe sex results in some 80 million unwanted pregnancies,⁷ 340 million curable sexually transmitted infections⁸ and 2 million people with new HIV infections.⁹ Given these stark statistics, it becomes imperative to strengthen linkages between these two areas of work.

Strengthening linkages between sexual and reproductive health and HIV has the potential to accelerate the attainment of universal access to health care and thereby the attainment of the Millennium Development Goals. By minimizing missed opportunities, we can increase access to and coverage of services for more people, including vulnerable populations, ensure services for people living with HIV that meet their needs and respect their rights, address issues of stigma and discrimination, and promote safe and responsible sexual behaviour for all.

The deadline for submissions to this issue is 15 March 2009. Manuscripts should be submitted to http://submit.bwho.org and should conform to the Guidelines for Contributors, available at: http://www.who.int/bulletin/volumes/84/current_guidelines/en/index.html. They should be accompanied by a cover letter mentioning this call for papers. All submissions will be subject to the Bulletin's usual peer review procedure.

References

Available at: http://www.who.int/bulletin/volumes/86/12/08-059394/en/index.html

References

1. Resources and funding for AIDS. Geneva: UNAIDS; 2008. Available at: http://www.unaids.org/en/PolicyAndPractice/ResourcesAndFunding/default.asp [accessed on 3 November 2008]          .

2. Towards universal access report: scaling up priority interventions in the health sector: progress report 2008. Geneva: WHO; 2008. Available at: http://www.who.int/hiv/mediacentre/2008progressreport/en/index.html [accessed on 3 November 2008]          .

3. Sexual & reproductive health and HIV: linkages: evidence review and recommendations. Geneva: WHO/UNFPA/IPPF/UNAIDS/UCSF; 2008. Available at: http://www.who.int/reproductive-health/hiv/linkages_evidence_review.pdf [accessed on 3 November 2008]          .

4. Antenatal care in developing countries: promises, achievements and missed opportunities: an analysis of trends, levels and differentials, 1990-2001. Geneva: WHO/UNICEF; 2003. Available at: http://www.who.int/reproductive-health/publications/antenatal_care/index.html [accessed on 3 November 2008]          .

5. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report. Geneva: WHO/UNAIDS/UNICEF; 2007. Available at: http://whqlibdoc.who.int/publications/2007/9789241595391_eng.pdf [accessed on 3 November 2008]          .

6. Sexual and reproductive health & HIV/AIDS: a framework for priority linkages. Geneva: WHO/UNFPA/IPPF; 2005. Available at: http://www.who.int/reproductive-health/stis/framework.html [accessed on 3 November 2008]          .

7. Reproductive health strategy to accelerate progress towards the attainment of international development goals and targets. Geneva: WHO; 2004. Available at: http://www.who.int/reproductive-health/strategy.htm [accessed on 3 November 2008]          .

8. Global strategy for the prevention and control of sexually transmitted infections: 2006-2015. Geneva: WHO; 2006. Available at: http://www.who.int/reproductive-health/stis/docs/stiskeymsgs.html [accessed on 3 November 2008]          .

9. Global AIDS epidemic update: 2007. Geneva: UNAIDS/WHO; 2007. Available at: http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf [accessed on 3 November 2008]          .

1 Correspondence to Manjula Lusti-Narasimhan (e-mail: lustinarasimhanm@who.int).
doi:10.2471/BLT.08.059394