Sexual and Reproductive Health of Women and Adolescent Girls Living with HIV: Guidance for Health Managers, Health Workers and Activists

This manual - coordinated by EngenderHealth, United Nations Population Fund (UNFPA), and the David and Lucile Packard Foundation - contains recommendations for creating programmes that protect and promote the sexual and reproductive health and rights of women and girls living with HIV and AIDS. Based on experiences in Brazil, the publication offers recommendations in four key areas: creating a political and social environment for promotion of sexual and reproductive rights; strengthening health systems to improve the availability of comprehensive sexual and reproductive health services; ensuring participation of adolescent girls and women living with HIV and AIDS in public policies and rights initiatives; and strengthening support available to them.

Among the recommendations that include communication are the following:

• Creating a political and social environment for promotion of sexual and reproductive health (SRH) rights;
  1. Take local realities and necessities into account, including the diversity of the female population in regard to age group, sexual orientation, disabilities, ethnic and cultural origins, religious persuasion, lifestyle (including drug use and alcohol consumption), and place of residence.
  2. Give special attention to those initiatives directed at linking SRH and HIV promotion and care, primary and secondary prevention, care and treatment for sexually transmitted infections (STI)/HIV, and actions that involve public policies for women, youth, education, culture, justice, social development, work, employment, and income generation.
  3. Guarantee the adoption of a cross-disciplinary, equitable approach to SRH care for women and adolescent girls living with HIV and AIDS that includes access to accurate information couched in suitable language.
  4. Ensure the participation of women and adolescent girls living with HIV and AIDS in the planning, implementation, monitoring, and evaluation stages of national policies.
  5. Promote studies, research, surveys, or initiatives that seek to identify and address those symbolic and material factors that have a negative influence on the quality of health services designed for women and adolescent girls living with HIV and AIDS.

• Strengthening health systems to improve the availability of comprehensive SRH services;
  1. Integrate into the curricula of graduate courses in human sciences and health sciences the themes of human rights, sexual rights, reproductive rights, ethnic/racial relations, gender relations, and diversity, in addition to questions related to overcoming stigma and discrimination associated with people living with HIV and AIDS (PLHIV).
  2. Foster the inclusion of the theme "social determinants of health conditions" in all permanent education activities for health workers, as well as the themes of living with HIV and AIDS and human rights.
  3. Broaden opportunities to update health workers’ knowledge about and skills on the SRH of HIV-positive women and girls through training and certification.
  4. Guarantee the integration of SRH and HIV programmes.
  5. Create opportunities for sharing and exchanging experiences and lessons learned in the promotion, defence, and enforcement of the rights of PLHIV.
  6. Guarantee the development of strategies to broaden participation and engagement of the male partners.
  7. "Within the sphere of the Plan for Confronting the Feminization of the Epidemics of AIDS and other STDs, develop communications and information strategies to promote the rights of PLHIV by guaranteeing the broad dissemination of communications products directed at health workers, health managers, health service users, and society at large."
  8. Raise the awareness of staff and researchers on issues of race, colour, and ethnicity.

• Ensuring participation of adolescent girls and women living with HIV and AIDS in public policies and rights initiatives;
  1. Strengthen the participation of women and adolescent girls living with HIV and AIDS as political participants in the formulation, monitoring, and evaluation of policies, plans, actions, and goals of national, state, and municipal programmes.
  2. Encourage qualification and permanent education processes for monitoring and evaluation of public policies.
  3. Document, systematise, and disseminate the lessons learned and good practices in the promotion, defence, and protection of the rights of PLHIV.
  4. "Stimulate and foster civil society initiatives to develop communications strategies and the production and dissemination of audiovisual materials, materials for radio and television, printed matter, and electronic media products adapted to the differing realities and needs of the audience and aimed at raising awareness about the feminisation of the epidemics of AIDS and other STDs, about positive prevention, about the rights of PLHIV (including their sexual rights and reproductive rights), about facing up to stigma, discrimination, and violence, and about other relevant themes."
  5. Establish indicators for monitoring the progress of integrating SRH and HIV services.
  6. Guarantee the participation of PLHIV.

• Strengthening support available to PLHIV.
  1. Organise health and social services in such a way that they attract young people by offering them a welcoming, friendly atmosphere and the possibility to construct shared solidarity.
  2. Train and certify staff in health, education, and other areas to work with adolescents and young people by adopting democratic and respectful postures that take into consideration the needs and expectations of PLHIV, and that respect their values, acquired knowledge, and life’s experiences, as well as their right to promote their autonomy and emancipation.
  3. Facilitate access to counselling services addressing SRH, use of alcohol and drugs, and prevention of HIV and AIDS among adolescents and young people undergoing social rehabilitation processes in correctional institutions.
  4. Stimulate and foster integrated, permanent training for professionals responsible for the care, education, culture, leisure, and sports of young people with legal problems, who are incarcerated, or who live on the streets.
  5. Stimulate and support the participation of adolescents and young PLHIV in the monitoring and evaluating of public policies and advocate for their rights.