Linked Response between
Reproductive Health and HIV/AIDS
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According to the recent updates on AIDS epidemic, globally, 40 million people are living with HIV/AIDS. In year 2003 alone, an estimated 5 million people acquired HIV. Of these, 700,000 are children under 15 years (Source: UNAIDS/WHO, 2003. AIDS epidemic update). HIV/AIDS poses a serious RH problem as heterosexual and prenatal transmission becomes the major causes for the fast progression of the epidemic. Many countries, particularly in Sub-Saharan Africa are currently experiencing a generalised HIV epidemic among the overall population. The epidemic has moved beyond the high risk groups (such as men having sex with men, commercial sex workers and injective drug users), reaching women and young people.

In Ethiopia, for example, 770,000 out of 1.5 million people living with HIV are women aged 15-49 (Source: UNAIDS/WHO, 2004. Epedemilogical fact sheet – 2004 update). In most city centres, HIV prevalence rates among pregnant women are as high as 20%. RH programmes, therefore is seen as a natural entry point to reach these groups, who are often neglected under the vertical system for HIV/AIDS prevention and care.

Linked response implies how RH and HIV/AIDS programmes could work more effectively together to encompass notions of integration, collaboration, coordination and independent but informed action. HIV/AIDS programmes, for instance, may integrate or provide referral for family planning counselling and services to its clients. An antenatal care clinic, on the other hand, may provide voluntarily counselling for HIV/AIDS and referral for HIV/AIDS testing.

The advantages of linking HIV/AIDS services are clear, as follows:

1. address the needs for better RH and HIV/AIDS prevention and care

2. increase client satisfaction through provision of more comprehensive services

3. improve cost effectiveness with better utilisation of existing health personnel and infrastructure

4. maximum utilisation of scare resources

ICOMP implemented a project in Ethiopia, Tanzania, Uganda and Zambia, with the goal to create a sustained impact on Sexual and Reproductive Health (SRH) and HIV/AIDS by increasing institutional capacity on linking RH and HIV/AIDS programmes. Funded by the World Bank, this project commenced on 1 June 2004 and ended on 31 August 2005.

A total number of eight NGOs – a RH and a HIV/AIDS organisation from each country participated in this project:

• Ethiopia - Pro Pride and Hiwot Ethiopia
• Tanzania - Chama cha Wanawake Kupambana Na Ukimwi Arusha (CHAWAKUA) and St Lucia Nursing Home
• Uganda - Uganda Youth Development Link (UYDEL) and Kyetume Community Based Health Care
• Zambia - Independent Churches of Zambia (ICOZ) and Network of Zambian People Living with HIV/AIDS (NZP+)

With the support of ICOMP’s resource person, these NGOs were sensitised on linked response: the concept, benefits, challenges and opportunities. The capacity building of these NGOs encompassed all levels, from the Board, Executive Director (ED) to staff, using tools developed by ICOMP. The Board members undertook a self-assessment test on governance for linked response and were trained accordingly. The Board and ED, with the participation of staff members developed a strategic plan for linked response. Prioritised areas for linking were identified based on the assessment of the feasibility, organisational fit, likelihood of success of the linked response strategy, as well as potential impact on RH and HIV/AIDS status in the area. An action plan for a small-scale intervention of linked response were developed by each NGO. During the implementation of these action plans, the Board and ED promoted linked response, and tried to generate resource for the full implementation of the interventions through networking and advocacy.

A dissemination seminar was organised in each country to share the experiences and lessons learned as part of the advocacy and networking activities. Case studies of the experiences and lessons learned were documented and disseminated through ICOMP’s website.

In summary, at the end of this project, for the overall purpose of increasing institutional capacity of RH and HIV/AIDS NGOs, the following outputs were achieved.

• Enhanced governance and leadership capacity of NGOs

• Interventions implemented

• Advocacy and networking

Linked Response Activities - Sensitisation session for RH and HIV/AIDS NGOs - Self assessment by Board members - Strategic plan development by Board, Executive Director and Staff - Action plan for and implementation of small-scale intervention - Networking and advocacy for resource mobilisation - Dissemination seminar for sharing of experiences and lessons learned - Wider dissemination of experiences through ICOMP’s website