On Tuesday 20th July, a morning session on “Integrating Sexual and Reproductive Health and Rights (SRHR) and HIV: Lesson Learned from the Field”, brought to the audiences a description on how linkages between SRHR and HIV are identified in each individual setting, main challenges face in services integration effort, matters whether perspectives on generalized or concentrated pandemic impacting an approach to integrative services, and recommendations on how to strengthen SRHR and HIV services integration.

The field experiences were delivered by four panellists comprising of Mariata de Vos of Mosaic Training Service and Health Centre for Women in South Africa, Drasko Kostovski of Health, Education, Research Association Macadonia, Elizabeth Castillo of Colombia, and Dudu Simelane from Swaziland.

Mariata de Vos-an executive director of Mosaic Training Service and Health Centre for Women in South Africa emphasized that the integrated program they work on focus on women in reproductive age started from 14 years old onwards. An adoption of reproductive-age point of view stresses that women who are in need of sexual and reproductive health and rights (SRHR) services are not limited to just pregnant women.

Mariata described her experiences working with 40 different organizations that promoting SRHR and eliminating Violence against Women (VAW) through UNGASS Forum process that if the women who are victims of domestic and sexual violence are in desperate needs of both HIV and SRHR services. That is to say, being sexual and domestic abused can heighten their possibility of being HIV infected, and their level of vulnerability is worse if they are not integrated into service provision process. Maria also highlighted that the study in 12 countries reported that there are so many linkages between SRHR and HIV that can be pursued, and a lot of services integration has been implemented on the ground level. However, integration at the policy level is still not desirably progressed.

In the context of Colombia, Elizabeth Castillo of Sexual Health and Gender Program shared that an entry point to integrate SRHR and HIV service permitted by daily service activities. Major challenge in service integration in Castillo’s point of view is that HIV/AIDS is regarded as a new topic, and SHRH health service providers are not familiar with that. However, HIV/AIDS related topics need to be included into traditional SHRH activities. “Good starting point is to start off with your daily activities”, she strongly urged. Castillo also emphasized that adopting a more broaden definition of health can yield greater opportunity for integration. Apart from biological aspect of health, mental and social components of health should be made more distinctively inclusive and explicit to enhance services integration. Therefore, SHRH specific issues of rape survivors and lesbian health could be looked into, and necessary tools can be developed responsively.

While in Eastern Europe, Drasko Kostovski of Health, Education, Research Association in Macadonia, explained that catering to the needs and demands of clients is crucial to the process of SHRH and HIV services integration. In doing so, an impact of providing treatment, care and support can be greater, and considered more practically responsive when the approach to service provision is broadened.

In addition, he emphasized its importance of advocacy and constant communications with stakeholders in order to obtain full support for SHRH and HIV/AIDS services integration initiative, and meanwhile minimizing possible opposition. Mr.Kostovski stressed that it is vitally necessary to monitor program activities undertaken within the process so as to tap into systematic and useful data to provide evidence-based recommendations for service improvement and for policy advocacy in the future. However, Macedonia’s experience informed that advocacy on sexual rights related issues can limitedly implemented within public health sphere?

Dudu Similane-an executive director of Family Life Association of Swaziland (FLAS) described how their current family planning (FP) program started off purposively with minimal HIV/AIDS related services e.g. peer education, HIV voluntary counselling and testing (VCT), and Program for parent-to-child transmission (PTCT) and so forth so as to gain wider acceptance instead of rejection at the very first stage.

However, Ms.Similane notably highlighted issue about burden on health systems due to SHRH and HIV/AIDS services integration. Since health services providers are required to give a wide range of services related to SHRH and HIV/AIDS, it is vitally important to equip health personnel with skills and knowledge to provide friendly services to general and special group of populations. Therefore, there is a need to record different services through out the process provided. Consequently it places tremendous burden on data management system.

All panellists agreed that it is crucial to ensure doable and sustainable integration of SHRH and HIV/AIDS services, it is fundamentally for organizations to have comprehensive understanding of the situation their key populations faced. In addition, strong partnerships with related organizations in the SHRH and HIV/AIDS counterparts can foster effective services integration.

By the end of session, participants raised two critical questions. Firstly, how is evidence collected obtain adequate and systematic data to support an argument of how SHRH and HIV/AIDS services integration have on improvement of client’s health outcome? Lastly, is SHRH and HIV/AIDS response ready to integrate financial resources at the policy level in this current world of decreased funding.