"Action on the recommendations in this guideline requires a strategy that is informed by evidence, appropriate to the local context, and responsive to the needs and rights of women living with HIV."
The World Health Organization (WHO) defines a woman-centred approach to healthcare as one that consciously adopts the perspectives of women, their families, and communities. This means that health services see women as active participants in, as well as beneficiaries of, trusted health systems that respond to women's needs, rights, and preferences in humane and holistic ways. To that end, the WHO consolidated guideline on the sexual and reproductive health and rights (SRHR) of women living with HIV is grounded in and advocates for a strengthened, comprehensive, woman-centred approach to SRHR. The guideline outlines evidence-based recommendations and good practice statements for key operational and service delivery issues that need to be addressed in order to uphold human rights and promote gender equality.
The starting point for this guideline is the moment when a woman learns that she is living with HIV, and it therefore covers key issues for providing comprehensive sexual and reproductive health (SRH) and rights-related services and support for women living with HIV. Unique to the development of this guideline, a global community survey was conducted on the SRHR priorities of women living with HIV (findings of this Global Values and Preferences Survey are included throughout the guideline). It highlighted challenges experienced by women living with HIV who fear or experience violence to safely disclose their HIV status, as well as human rights violations related to their sexuality and reproduction within their families, communities, and health-care institutions. Thus, particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes.
More specifically: "Implementing comprehensive and integrated SRHR and HIV programmes to meet the health needs and rights of the diverse group of women living with HIV requires that interventions be put into place to overcome barriers to service uptake, use and continued engagement. In all epidemic contexts, these barriers occur at the individual, interpersonal, community and societal levels. They may include challenges such as social exclusion and marginalization, criminalization, stigma, gender-based violence and gender inequality, among others. Strategies are needed across health system building blocks to improve the accessibility, acceptability, affordability, uptake, equitable coverage, quality, effectiveness and efficiency of services for women living with HIV. If left unaddressed, such barriers undermine health interventions and the SRHR of women living with HIV."
Developed by the WHO Department of Reproductive Health and Research (RHR), this guideline is meant to help countries to more effectively and efficiently plan, develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV, taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address as they take a woman-centred approach, which is founded upon these guiding principles:
- Human rights: An integrated approach to health and human rights lies at the heart of ensuring the dignity and well-being of women living with HIV. This includes, but is not limited to: the right to the highest attainable standard of health; the right to life and physical integrity, including freedom from violence; the right to equality and non-discrimination on the basis of sex; and the right to freedom from torture or cruel, inhuman, or degrading treatment. The right to SRH is an integral part of the right to health, enshrined in article 12 of the International Covenant on Economic, Social and Cultural Rights.
- Gender equality: The promotion of gender equality is central to the achievement of SRHR of all women, including women living with HIV in all their diversity. This means recognising and taking into account how unequal power in women's intimate relationships, harmful gender norms, and women's lack of access to and control over resources affect their access to and experiences with health services.
Tables 1 and 2 (see pages 4-11 of the executive summary standalone document) present the new and existing recommendations and good practice statements, respectively. Figure 2.1, at the end of Chapter 2 (also known as figure 1 within the summary document; see page 12), presents a visual framework that brings together all the elements of the guideline, with women living with HIV at the core. This framework illustrates the essential structure of this consolidated guideline and points the reader to specific topics and relevant WHO recommendations (REC) and good practice statements (GPS). The values and preferences of women living with HIV, as expressed by respondents in the Global Values and Preferences Survey, are at the core of this guideline, which is grounded in and advocates for a comprehensive, woman-centred approach to SRHR, and is underpinned by the guiding principles of gender equality and human rights (represented in the pink circle). With this as a foundation, the framework then shows: (A) the encompassing enabling environment (outer purple circle), with all the eight topics as presented in Chapter 3 of the full guideline document (starting at the top and running clockwise); and (B) the health interventions (central teal segments), with all six topics as presented in Chapter 4 of the full guideline document (also clockwise from the top) - in all cases, these topics are accompanied by information on the relevant numbered RECs and GPSs, which are also listed in Tables 1 and 2, respectively.
Editor's note: The Canadian Webinar Series on Sexual and Reproductive Health and Rights is offering a multi-phase series of webinars focused on key aspects regarding the SRHR of women living with HIV in Canada. In that country, many women living with HIV report experiencing, and/or fear experiencing violence and stigma, among other challenges, when disclosing their HIV status to family, friends, service providers, and/or sexual partners; this is particularly the case for those who experience multiple and intersecting forms of discrimination. In Canada, where HIV non-disclosure is criminalised, women living with HIV must navigate additional structural challenges to disclosure. The topic of the November 16 2017 webinar (click here to register; contact Rebecca Gormley firstname.lastname@example.org for more information) was Supporting Safe HIV Disclosure: Implementing the WHO Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV. It brings together perspectives from women living with HIV, front-line community workers, researchers, clinicians, and policymakers who will share key considerations and highlight research and service gaps from the African, Caribbean, Black, and Indigenous communities, emphasising the importance of integrating principles of the meaningful involvement of women living with HIV (MIWA) when designing interventions and recognising women's resilience. [Click here to watch a recording from the first webinar, also on the consolidated guidelines.]
Posting from Ados May to the IBP Global Knowledge Gateway on October 23 2017; WHO website and WHO Press Release, February 21 2017 - both accessed on November 9 2017; and email from Rebecca Gormley to The Communication Initiative on November 14 2017. Image caption/credit: A health worker counsels a woman, Bangladesh. WHO/SEARO/Gary Hampton