SRHR and HIV Linkages Index 2016: Key messages

The intrinsic connections between HIV and SRHR are well-established, especially as HIV is predominantly sexually transmitted or associated with pregnancy, childbirth and breastfeeding. The following are key messages from the 2016 SRHR and HIV Linkages Index.

  1. Reaching joint SRHR and HIV targets through a linked SRHR and HIV response requires going beyond health services to address wider human rights and development concerns.
    • An enabling environment for a fully linked SRHR and HIV response, including through supportive laws and policies, is the lowest scoring domain across all regions reflecting significant HIV- and SRH-related human rights, legal and development challenges facing countries, as well as gaps in the availability of data.
    • Income status of countries is an influencing, but not an exclusive, driving factor determining the composite SRHR and HIV linkages score. Health systems and service delivery domain scores are positively linked with income level, but the enabling environment score is not directly correlated with income level, suggesting that efforts to create a policy and legal environment supportive of human rights, including freedom from violence, stigma and discrimination, are not dependent on economic status.
  1. SRHR and HIV strategies and policies should be connected to increase integrated service provision and client uptake.
    • Countries were assessed to see whether HIV strategies had five identified SRHR components explicitly articulated as a goal or target and similarly whether SRHR strategies had five identified HIV components explicitly articulated. On average, countries are 62% of the way toward achieving the target for the HIV strategy indicator compared to only 32% for the SRHR strategy indicator. Therefore, there is considerable scope for HIV and SRHR strategies and policies to be less siloed.
  1. People living with HIV and key populations often face related stigma and discrimination, violating their human rights. Furthermore, a non-supportive legal and policy environment interferes with client utilization of SRHR and HIV prevention, treatment, care and support services.
    • There are three key factors driving a more positive enabling environment score for SRHR and HIV linkages: the self-reported low level of stigma hindering access to SRH services for people living with HIV, the presence of a supportive legal environment for people living with HIV, and the age of consent for marriage set at 18 years or older. However, due to limitations in data, including the possible underreporting of stigma, as well as the persistence of tacit discrimination, human rights abuses continue. The lowest scoring indicators in Domain 1 show that the rights of people living with HIV are still being violated with few able to access legal redress and women living with HIV continuing to experience forced sterilization.
  1. Criminalization of key populations, including men who have sex with men, people who inject drugs, sex workers and transgender people, violates rights and limits access to health services, increasing vulnerability to negative SRHR and HIV outcomes, stigma, discrimination, and violence.
    • There is a punitive and restrictive legal environment for people who inject drugs, sex workers and men who have sex with men. Selling or buying sex is illegal in 65% of countries, 55% of countries have laws which criminalize the sexual activities of men who have sex with men, and people who inject drugs are almost universally criminalized.

  1. Given the centrality of the health workforce for improving the delivery of services and hence health outcomes, increasing the number of skilled health workers is critical, although integration can work to improve the efficiency of existing health workers.
    • The number of skilled health workers – both physicians and nurses/midwives – is far below the target, and only 8% of the index countries have achieved it.
  1. Providing integrated SRHR and HIV services enables clients to receive as many quality services as possible at the same time and in the same place, especially at the primary healthcare level.
    • 80% of countries have reported that ‘many’ SRH facilities provide integrated HIV testing and counselling. Yet, the poor overall coverage of HIV testing and counselling sites remains a challenge. Given the high coverage levels for contraception within primary healthcare facilities, the family planning platform offers the opportunity to provide additional HIV testing and counselling services, and vice versa, increasing overall access to and delivery of integrated services.
  1. Client access to and utilization of a full range of HIV and SRHR commodities is essential for a successful SRHR and HIV linked response.
    • While a majority of countries have reached an average of 91% of the ambitious target of 100% for no ART stock-outs, most countries have been less successful – though still effective – in avoiding stock-outs for contraceptive commodities with an average of 71%.
    • Condoms are currently the only effective multipurpose prevention technology that, when used consistently and correctly, provide triple protection against HIV, other sexually transmitted infections and unintended pregnancy. Most countries are only reaching half of the set target of 90% condom use during the most recent sexual activity for adults with multiple sexual partners.
  1. Initiatives are now ongoing for dual elimination of mother-to-child transmission of HIV and syphilis requiring integrated service delivery.
    • Countries are 65% of the way toward achieving the global target of a vertical HIV transmission rate less than 5% and are 54% of the way toward achieving the target of 95% of pregnant women screened for syphilis at the first antenatal care visit. Implementation of integrated SRHR and HIV services requires coordinated action at facility-level to provide a total package of family planning, maternal, and newborn health, integrated with HIV and other STIs.