Suzanne Ehlers, Mercedes Mas de Xaxas, and Felicity Daly RHSC, London/ June 5, 2009 Leveraging Monies for HIV Integration and Prevention

Mobilizing for RH/HIV Integration Assists and supports Country Coordinating Mechanisms and indigenous Civil Society Organizations in the development and submission of proposals to the Global Fund to Fight AIDS, TB and Malaria that integrate reproductive health, including supplies, as a critical component of HIV prevention, treatment, care and support Urges need for intensification of integration as a key opportunity to increase the relevance, cost-effectiveness and impact of programmes and policies on both RH and HIV outcomes

RH/HIV Integration Integration can be broadly defined as various types of sexual and reproductive health/family planning and HIV/AIDS services or operational programmes that can be joined together to enhance outcomes.* Linking RH/FP and HIV/AIDS policies and services can contribute to addressing wider structural issues that affect people’s ability to prevent HIV transmission. * WHO, UNFPA, UNAIDS, and IPPF, 2008a.

Why Link Reproductive Health and HIV/AIDS? Integrating Reproductive Health and HIV/AIDS increases people’s access to a range of information and services that affect HIV outcomes. This is important particularly for women and young people since: – women now account for nearly 60% of HIV infections in sub- Saharan Africa – young people aged 15 to 24 account for an estimated 45% of new HIV infections around the world.* *UNAIDS AIDS Epidemic Update December Geneva: UNAIDS.

Why Link Reproductive Health and HIV/AIDS? Despite advances in treatment, nearly three individuals become infected with HIV for every one person who begins antiretroviral treatment.* To expand prevention efforts, reaching people at risk of HIV through all appropriate program entry points is critical, including crucial reproductive health programs, services and supplies. *United Nations General Assembly “Declaration of Commitment on HIV/AIDS and Political Declaration o n HIV/AIDS: Midway to the Millennium Development Goals”. Report of the Secretary-General. New York: United Nations.

Benefits of RH/HIV Integration Meeting the ICPD PoA Integration of RH/HIV is one way to fulfil the ICPD Programme of Action (POA) -- an agenda for comprehensive approaches to sexual and reproductive health and rights which has not been consistently implemented, partly due to inadequate levels of financial support.

Benefits of RH/HIV Integration Meeting the MDGs Integration of RH/HIV is important to achieving significant progress on commitments to the MDGs, such as: –MDG 4: reduce childhood mortality –MDG 5: reduce maternal mortality/achieve universal access to reproductive health –MDG 6: significant improvements in access to HIV treatment and in halting and reversal of the spread of HIV/AIDS and other infectious diseases.

Donor Funding for RH/HIV Based on a re-costing of ICPD –research PAI participated in -- donors pledged to provide US$9.7 billion per year to implement the POA. They are falling far short of meeting these goals. Collectively donors have never fulfilled their 1/3 share of population assistance. Much of the increase in funding for ICPD goals was related to responses to HIV and AIDS treatment and care.

Donor Funding for RH/HIV Revised estimates of the minimum resources to meet the ICPD goals from 2009 onward start at US$50 billion in 2009 scaling up to US$70 billion in There is strong evidence that many governments are failing to adequately prioritize sexual and reproductive health and rights in development planning.

Why the Global Fund? Unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. Partnership between governments, civil society, the private sector and affected communities and represents a new approach to international health financing

Why the Global Fund? The Global Fund’s approach places particular importance on country ownership and demand. Supports involvement of reproductive health organizations to ensure proposals take into account a comprehensive approach to RH/HIV integration Main source of financing for programs to fight AIDS, tuberculosis and malaria (since 2002, funding of US$ 11.4 billion for more than 550 programs in 136 countries.

Key Success Of the 10 countries assisted, 9 submitted integrated proposals. Burundi, Ghana, Madagascar and Zambia were recommended for funding, leveraging tens of millions of dollars for RH/HIV integrated programs Global Fund resources are also contributing to improved linkages at policy level between traditionally separate processes of planning and monitoring of SRH and HIV efforts Round 8 marked the first grant cycle where countries have requested reproductive health commodities beyond condoms in their proposals.

Key Successes: Country Examples Burundi Procurement, promotion and/or provision of condoms – Purchase and distribution of 67 million male and 9.4 million female condoms over 5 years, prioritising populations most at risk for HIV, other STIs and unwanted pregnancy. Provision of comprehensive family planning services – Training for 600 health care staff at facilities serving HIV-positive people to improve ability to provide family planning services. – Awareness raising of family planning options and location of services for women of reproductive age and people living with HIV by 425 community members from 85 civil society organizations.

Key Successes: Country Examples Ghana Provision of comprehensive family planning services – Training of all midwives in HIV counseling and testing and STI services and their integration with family planning. Development of guidelines and standards to facilitate integration in collaboration with the Ghana Registered Midwives Association. – Increase in couples HIV counseling, addressing male partners and discordant partnerships. – Procure and Distribute 480,000,000 condoms to the general population, including MARP’s and vulnerable groups for dual protection

Key Successes: Country Examples Zambia Procurement, promotion and/or provision of condoms – Procurement and free distribution of 2 million male and 600,000 female condoms per year. Provision of comprehensive family planning services – Acquisition of family planning commodities, including multiple types of contraceptives and safe delivery supplies. Covers 30% of Zambia’s total financial gap for such commodities. – Training of 1,200 community health works with an updated curriculum on health education to provide family planning, prevent HIV transmission and address domestic violence - to reduce HIV prevalence and maternal mortality. Note: Madagascar is the only country that didn’t include costs for procuring supplies, but says those are funded by other sources.

Forthcoming Publication “A Practical Guide to Integrating Reproductive Health and HIV/AIDS into Grant Proposals to the Global Fund” A guide for national-level partners that includes: – What is integration? – What is the evidence that integration makes a difference to HIV outcomes – Given a country’s context, what policies and programs could be integrated? – What is Needed for Successful Integration – How can integration be monitored and evaluated? – Selected manuals and materials for integrated services

THE FUTURE The Initiative aims to increase the linkage/integration of RH/HIV in policies, programs, and services through a continued focus on the Global Fund and its processes. Continue to build targeted advocacy at the global, regional and national levels for resources to support integration of SRH and HIV programs, services and supplies.