Empowering young people to take control of their sexual and reproductive health and rights

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Integrating HIV and SRHR services

<p>Link Up in Uganda</p>

It had always been either you have a niche in HIV, or it is SRH, but not both. If you tell people about HIV issues, then what? What about their reproductive health? What about their advocacy?

- Gracie Nakazzi, Community Health Alliance Uganda

Meeting diverse needs

To better meet the diverse needs of young people most affected by HIV, Link Up focused on integrating HIV services with services relating to sexual and reproductive health and rights (SRHR).

A key element of this was working with Marie Stopes International (MSI) to provide integrated SRHR and HIV services in public and private clinics and linking up services between health facilities.

As a result, more than 225,000 young people affected by HIV have been reached with integrated services in facilities.

For country-by-country statistics, visit our Results page.

CASE STUDY
A voucher for health

Link Up built on MSI's wide experience of voucher schemes to utilise the large but unregulated private health sector in Uganda. This incentivised health providers to deliver key integrated SRHR/HIV services at greatly improved standards.

The scheme

  • Each voucher entitled its owner to two visits for HIV testing, three visits for family planning and three visits for STI management.
  • All services were free.
  • Young people helped design and test the vouchers.
  • 70 young people distributed the vouchers over the course of a year. They also offered health education and accompanied young people to the clinics if requested.
  • The young distributors were paid by health facilities for every voucher redeemed, with ‘mystery shopper’ exercises conducted to ensure the authenticity of services claimed.
  • In the same year, 80 clinical officers and nurses from 40 health facilities and clinics were trained to work with young people most affected by HIV including young sex workers, young people living with HIV and young men who have sex with men.
  • Additionally, 44 young people from key populations were trained then stationed at clinics to assist young people during their visits.

Results snapshot

  • The scheme extended SRHR and HIV services to nearly 30,000 young people in one year.
  • The greatest uptake of services was for HIV counselling and testing (92%), STI management (75%) and family planning (37%).
  • There was a noticeable shift in family planning uptake – 51% received long-term family planning services and 49% received short-term family planning services.
  • The scheme was successful in reaching young people who sell sex (1,438), slum dwellers (4,188) and young people living with HIV (225). The presence of young people from key populations as both voucher distributors and facility-based volunteers was key to this.
  • Young men who have sex with men were harder to reach.

To read more about Link Up's voucher scheme read our in-depth case study A voucher for health.

 

Link Up has also supported community-based organisations and health facilities to work together to bring integrated SRHR and HIV services to the most hard-to-reach young people.

In Uganda, Link Up has reached more than 296,000 young people with integrated services in a community or home based setting. The project worked with four implementing partners in the country, each of which has now broadened its remit to include both SRHR and HIV services. To find out more read Models of integrated care for young people in Uganda.

Transforming services through training and technical support

Improving the way young people who access SRHR and HIV services are treated was one of Link Up's key focuses. The programme supported and strengthened the technical capacity of around 3,500 public and private health providers and health extension workers. A series of tailored, technical support packages on SRHR and HIV integration, peer outreach, monitoring and evaluation, policy and advocacy has also been provided to implementing partners.

Building skills

The following Link Up tools have been designed to help health care workers adapt their services to meet the diverse sexual and reproductive health needs of young people most affected by HIV.

Sexual and reproductive health and rights, and HIV 101 workshop guide.

link up 101A guide to facilitating a workshop on linking up HIV and SRHR with young key populations. This 101 training programme on SRHR and HIV integration outlines a five day course designed to make service providers more aware of the needs of young people who sell sex, young people living with HIV, young men who have sex with men and young transgender people. Its aim is to decrease stigma and increase client satisfaction.


Workshop guide: Integration works!

integration works

This facilitator’s guide presents a four-day workshop designed to develop a common understanding on how to integrate HIV and SRHR and enables participants to explore the benefits and challenges of integration.


Good Practice Guide Integration of HIV and Sexual and Reproductive Health and RightsGood Practice Guide

This good practice guide brings together expertise from the Alliance global community, current research and other key external materials on the integration of of HIV and SRHR services. It contains information, strategies and resources, which define Alliance Good Practice Programming Standards, on how to programme integrated HIV/SRHR services in an effective manner.


For an evaluation of Link Up's impact on health workers' attitudes towards young people most affected by HIV in Bangladesh, visit our Research and evidence page.