Stronger linkages between Sexual and Reproductive Health (SRH) and AIDS programmes have proved to have multi benefits to both the clients and the health sector in Malawi, health experts and the project beneficiaries have confirmed. The United Nations Population Fund (UNFPA) and the UNAIDS, the joint United Nations Programmes on HIV/AIDS along with the European Union (EU) are strongly advocating for closer linkages between HIV/AIDS interventions and SRH care having observed that the initiative is making sense in terms of public health benefits.

“It has proved to be convenient, economic efficiency and promoting human rights,” disclosed a UNFPA National Programmes Coordinator for SRH and HIV/AIDS Thandiwe Mijoya. And an official in the ministry of health reproductive health unit, Hanz Katengeza, disclosed that in Malawi the project is under pilot in some 15 health centers in Mangochi (southern region), Dedza (central region) and Nkhatabay (northern region). Said Katengeza: “We are very impressed with what is happening. It has proved to be a success and the lessons learnt from the pilot project will eventually be used to replicate to medical facilities across the country.”

According to the health experts, some of the benefits of the integration are improved access to and uptake of key services, better access of people living with HIV to services tailored to their needs, reduced Aids-related stigma and discrimination. “There is also improved coverage of undeserved and marginalized populations, greater support for dual protection against unintended pregnancy and sexually transmitted infections, improved quality care and enhanced programme effectiveness and efficiency,”added Katengeza. In Mangochi at Mkumba health centre, where the project rolled out, a Nurse/Midwife Technician (NMT) Thokozani Chaona disclosed that there is an increase in the uptake of HIV services. “Before we adopted the project we could close all other services at the clinic for one day in a week to carry out antiretroviral (ARV) and antiretroviral therapy (ART) services. “There was no guarantee and this was not working well because many clients would find it stigmatizing because the whole community knew which people were coming for to the clinic to seek HIV services. Un fortunately they would shun the clinic even if they were very sick,” lamented the NMT.

Now that the health centre conducts ARV and ART services routinely together with SRH services, a community leader in the district explained that Mkumba is becoming popular, renowned and distinguished for its good and effective practices in linking HIV/AIDS services with sexual and reproductive health rights services, further narrating that the initiative has also brought much bond in families. “The linkages project is good. It is friendly and has proved to be effective. We have even seen men accompanying their partners when they are coming for ante-natal care,” he said. A senior surveillance assistant at the centre, Francis Kalunga revealed that previously people could be seen loitering around the health centre as they could not gather courage to come and seek HIV services. “They were avoiding finger pointing which usually happens to people living with HIV in the communities, but now nobody is exposed to that kind of situation because the provision of services is well integrated,” said Kalunga. The medical staff indicated that at the clinic post-natal care and youth friendly services for reproductive health are also promoted by integrating in the other services provided at the health centre. It has been observed that linking HIV and AIDS interventions with the general reproductive health services also strengthen both types of services as they face the same health system challenges.

Some of the notable challenges are shortages of trained staff, essential supplies and equipment, adequate facilities, and management skills. “Both face similar obstacles in dealing with sensitive taboo subjects. They both require similar supplies and the same types of health provider skills,” observed an official at the ministry. In Malawi it is reported that 26 percent of women have an unmet need for effective contraception, and consequently a high proportion of unintended pregnancies.

Many of these women, reports the ministry, do not know their HIV status, have limited access to information and services, and thus risk passing the virus to their children. “Under these circumstances, access to even a minimal integrated package of care-including family planning, management of sexually transmitted infections, Hi prevention and maternal health- can enable the women to protect themselves from both unintended pregnancies and HIV and also prevent HIV transmission to their children,” narrated Mijoya of UNFPA.

Initiated two years ago by the ministry of health, the project is financed by the EU with technical support from UNFPA and UNAIDS.