1. Condoms as a catalyst For integrating sexual and reproductive health (SRH) & HIV services

2. Condom Is it for HIV prevention? Contraception? Protecting sexual health? It is… … the ultimate integrated service…!

3. Linking SRH & HIV  Policy  Addressing structural determinants of HIV and SRH  Determining the level and effectiveness of linkages between SRH and HIV-related policies, national laws, operational plans and guidelines  Systems  Assessing systems to determine extent to which they support effective SRH &HIV integration and linkages  Weakness of health systems is responsible for many gaps that impede full enjoyment of right to health  Service delivery (integration)  Joining together a wide range of SRH and HIV services to ensure collective outcomes  Evaluating different models for delivering HIV services in existing SRH facilities

4. Linkages: pre-Integra scenario Real commitment at global level to intensifying linkages between SRH & HIV at programmatic and policy levels. The rationale for doing so is clear but we need to gather evidence on how to link HIV and SRH. The Cochrane Systematic Review conducted in 2007 showed a lack of evaluative studies on the benefits of linking HIV & SRH. Integra goal: To strengthen the evidence of the benefits and costs of a range of models for delivering integrated HIV and SRH services in high and medium HIV prevalence settings for reducing HIV (and associated stigma) and unintended pregnancies.

5. Rationale and emerging themes SRH & HIV integration: 1. Is an important part of the global response to HIV 2. Is context specific - no blueprint 3. Makes good people sense – it can reduce stigma 4. Can provide an effective way to more efficiently use scarce resources, both human and economic 5. Can reach out to a ‘broader audience’ and increase uptake of services 6. Hinges on a ‘tipping point’ at which more investment may be needed to ensure that efficiency gains are made and services not over strained 7. May call for creative solutions.... to enhance planning, budgeting and management; the capacity or skills of health care providers; overcome fear of the unknown or fear of increased workload; and find solutions to commodity stock-outs or supply chain blockages.

6. Operations research 2008-12 IPPF, Population Council and London School of Hygiene and Tropical Medicine 3 countries in Africa: The Integra initiative Kenya: FHOK and government facilities Clinics overall: 30 government and 6 FHOK Swaziland: FLAS and government facilities Clinics overall: 14 government and 2 FLAS Malawi: FPAM Clinics overall: FPAM (4 clinics, 1 community based and 55 outreach)

7. Family Planning Association of Malawi - FPAM an NGO providing Youth Friendly Sexual and Reproductive Health services in Malawi affiliated to International Planned Parenthood Federation (IPPF) as a Member Association Malawi population -13.1 million Maternal Mortality Rate (per 100,000 live births) - 675 Total fertility rate - 5.7 Contraceptive Prevalence rate – 46% (Modern= 42%, Tradition= 4%) Unmet need for FP - 28%

8. Effect of Intervention in Malawi FPAM: 7 fold increase HIV; 11 overall

9. Thank you Ruth Kundecha HIV Focal Point and Community Based Services Manager Family Planning Association of Malawi (FPAM) www.integrainitiative.org