HIV services for women in Latin America must be closely integrated to make sure nobody is left behind in ending the epidemic.
HIV services for women in Latin America must be more closely integrated to make sure nobody is left behind in the push to end the epidemic. This was one of the recommendations from a workshop led by the UN Development Programme (UNDP) in Montevideo, Uruguay from 13-15 October.
The workshop focused on the legal environment and HIV in Argentina, Brazil, Chile, Uruguay and Paraguay. Representatives from governments, civil society organisations, universities and the legal profession attended the workshop, which also touched upon the sustainability of the HIV response.
All the countries represented at the workshop are middle-income countries, where HIV is less prevalent and Official Development Assistance funding has dried up or is on the way out. It is crucial that these countries innovate and diversify both their funding strategies and tactics for reaching the most vulnerable people.
What are integrated services?
One of the tactics mentioned in the workshop, although not stressed nearly enough, was that of integrating HIV with other health services. The concept of integrating health services has different implications depending on the context.[1] Essentially the objective is that people get the care they actually need, even though those needs are often complex and multi-layered. For example, a person living with HIV may be more vulnerable to other infections, such as Hepatitis B, C and TB. There may also be other consequences such as stigma, discrimination and violence.
Globally, progress has been made in terms of integrating HIV treatment with that for co-infections and developing health services tailored to the needs of people most at risk of infection; gay men and men who have sex with men, transgender people, sex workers and people who inject drugs.
Nevertheless, there is still much to be done to ensure that women and girls, especially those who are victims of or at risk of sexual violence, do not fall through the cracks of national HIV responses. For example, it is critically important to provide comprehensive health services to women who have experienced sexual violence, including sexual and reproductive health services such as emergency contraception, safe abortion care, HIV prevention and treatment and psychosocial support.
Gender based violence
Sexual violence, and gender inequalities more generally, place women and girls at greater risk of contracting the virus and women living with HIV are more vulnerable to being abandoned by their families or partners, left destitute, beaten, or even killed.[2]
During the workshop, findings were presented from a joint research project undertaken by civil society organisations from across Latin America from 2014 to 2015 to monitor violence against women, the HIV epidemic and its impact on women across the region. The project, ‘Incorporating violence against women in national HIV responses’, was coordinated and implemented by Gestos, a Brazilian civil society organisation, and delivered by partner organisations in Argentina, Colombia, Peru and Uruguay.
In Uruguay, HIV prevalence among the general population is low (0.6 – 0.8 per cent). The epidemic is concentrated in key populations and is at its highest among transgender people (21 per cent), especially those involved in sex work (23 per cent).
Violence against women in Uruguay
According to the NGO implementing the project in Uruguay, Mujer y Salud en Uruguay (MYSU), not enough is being done to integrate HIV initiatives with those designed to tackle violence against women. This is pertinent in Uruguay because women face shockingly high levels of violence.
According to national statistics, 68.8 per cent of women aged 15 and over have experienced gender based violence at some point in their lives. That’s seven out of 10 women.[3] In its report, MYSU also argues that there has been a feminisation of HIV in the country, meaning that there has been a gradual increase in the number of women diagnosed with HIV in relation to men in the country.[4]
In 2008, MYSU monitored gender based violence and the feminisation of the HIV epidemic as part of another regional project coordinated by FEIM, Argentina.[5] Two per cent of the women interviewed in Uruguay admitted that they took their HIV test because they had been raped, while 38 per cent claimed they had suffered violent episodes once they had received their diagnosis.[6] This suggests violence is both a cause and a consequence of HIV among women in Uruguay.
Training health and legal professionals
Uruguay has some progressive legislation in place (including the 2008 Right to Sexual and Reproductive Health law) and services to combat HIV and gender based violence do exist. However, the challenge now lies in integrating these services with a view to providing women with comprehensive sexual and reproductive health services which meet their specific needs.
In its 2014 report, MYSU calls for services to be decentralised and the primary care level strengthened. It also recommends that more work should be done in the area of prevention and education to raise awareness of the relationship between HIV and gender based violence.
Moreover, MYSU’s report stresses the need for sexual and reproductive health teams to be multidisciplinary. Maru Casanova, a MYSU researcher involved in the report, said: “Teams should include various healthcare professionals, such as gynecologists, social workers, psychologists and infectologists. They should approach a person living with HIV in a comprehensive way, taking into account the various healthcare requirements of that person and the need to coordinate with other sectors if needs be.”
In Uruguay, integrating HIV services in smart ways, which put people at the centre, could be crucial in the country’s final push to making sure nobody gets left behind in its quest to end AIDS by 2030.
Read about how stigma deters young people from accessing contraception
[1] WHO, Technical Brief No.1, May 2008, ‘Integrated Health Services - What and Why?’
[2] UNAIDS, ‘Agenda for accelerated country action for women, girls, gender equality and HIV’
[3] MYSU, ‘Monitoreo VIH y violencia contra las mujeres: Situación de las dos pandemias en Argentina, Brasil, Colombia,Perú y Uruguay. Informe Uruguay.’ P.18
[4] Ibid. P.11
[5] “Dos caras de una misma realidad: violencia contra las mujeres y feminización del VIH/sida en el MERCOSUR”
[6] MYSU, ‘Monitoreo VIH y violencia contra las mujeres: Situación de las dos pandemias en Argentina, Brasil, Colombia,Perú y Uruguay. Informe Uruguay.’ P.29
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