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HIV and STIs

The majority of HIV infections are sexually transmitted or are associated with pregnancy, childbirth and breastfeeding.  Our work links prevention with treatment, care and support, reduces HIV-related stigma and discrimination, and responds to unique regional and national characteristics of the epidemic.

Articles by HIV and STIs

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IMAP Statement on Person-centred Care for Sexually Transmitted Infections

Recognizing the significant global impact of sexually transmitted infections (STIs), this statement affirms IPPF’s commitment to people-centred STI care as a critical aspect of comprehensive sexual and reproductive health and well-being. A holistic approach to sexual and reproductive health and rights acknowledges that true sexual and reproductive well-being extends beyond the prevention and treatment of diseases. It emphasizes the importance of promoting healthy, satisfying sexual and reproductive experiences. This includes advocating for personcentred care, encouraging self-care strategies, and supporting the development of innovative healthcare delivery models tailored to meet the diverse needs of individuals in various circumstances and contexts, particularly reaching those who are often excluded and marginalized. This statement updates the latest information on STIs. It provides practical recommendations for IPPF Member Associations on how to develop a comprehensive, people-centred approach to STI care, emphasizing integrated services, adherence to guidelines, rights-based care, community engagement, advocacy, and a positive perspective on sexual health and well-being.

lesotho-hiv
01 December 2023

Step on the Red Carpet: Lesotho’s Youth Receiving Premium SRHR Services through IPPF’s Member Association

Lesotho, a country situated in Southern Africa and landlocked by the Republic of South Africa, has an estimated total population of 2.1 million people. The small country is still heavily affected by HIV and AIDS, with high prevalence rates of 24.3% among women aged 15-49, and 14.2% among men in the same age bracket. The Lesotho government, in partnership with various non-governmental organizations, continues to address these alarming rates, including among adolescents and youth. One of the government’s key partners in the country is IPPF’s Member Association in Lesotho, Lesotho Planned Parenthood Association (LPPA). One of LPPA’s strategy aimed at increasing HIV linkage and retention in care and treatment among adolescents and young people living with HIV, is through an initiative known as the ‘Red-Carpet model’. The initiative, started in May 2023, is being piloted in LPPA’s youth clinic located in the capital city, Maseru. The ‘Red-Carpet model’ is aimed at providing adolescents and young people with a VIP experience as they access quality youth-friendly services at the facility. The model fast tracks services and reduces barriers for adolescents to access and utilize integrated HIV/SRH services. We had a chat with Ms. Mamojela Koneshe, LPPA’s Executive Director, who sheds more light on this initiative. How exactly does the ‘Red-Carpet’ model work? The model serves all adolescents and young people who visit the clinic, regardless of if they are first time or returning clients. For the new clients, they first report to the reception area upon arrival at the clinic. They are then referred to the waiting area where an LPPA Youth Ambassador gives them information about the model, how it works and its benefits. Youth Ambassadors are young people seconded to LPPA clinics by one of our partner organizations - Elizabeth Glaser Paediatric AIDS Foundation (EGPAF). Their duties include ensuring that adolescents in the clinic are linked to appropriate HIV prevention methods and treatment. They also hold scheduled peer support groups, and in collaboration with the Youth Nurse, link vulnerable youth to various organisations depending on their needs –for example linking sexual and gender-based violence survivors to shelters. The Youth Ambassadors also ensure that red carpet model is well implemented. While at the waiting area, the Youth Ambassador gives the adolescent or young client access to free wi-fi, which enables them to access the internet. After this, the client is enrolled in the model and given a VIP card. When their turn arrives, the Youth Ambassador escorts them to the relevant consultation or counselling room depending on the service they need. The expected time spent in the facility by the young person is 45minutes. This is the maximum time expected to be spent by young people while accessing services and was informed by the various services that young people access in our facility. Telephone follow-up interviews are then done with the clients on a weekly basis. On their return visit, upon arrival at the facility, adolescents report to the reception where they present the VIP card they were given at their first visit. They are then referred to the waiting area where once again, the Youth Ambassador gives them a free wi-fi voucher and links them to the appropriate service. Similarly, the expected time spent in the facility is 45minutes. Why is the provision of free internet to adolescents and youth at the clinic important? This is because it enables young people to access a vast amount of health information online. By connecting to the internet, they search for health-related information. It also gives them access to educational resources that can help them make informed decisions about their health. Going online also helps them to connect with their peers within established peer support groups. In addition, most of our clients are students at colleges, universities, and other learning institutions, so facilitating their free internet access helps them to continue studying and researching while waiting for services. They like this since they don’t have to use their own internet bundles, which can be quite expensive for them.

HIV

HIV Theory of Change

Background IPPF offers a comprehensive approach to sexual and reproductive health and rights through its Integrated Package of Essential Services (IPES) which is offered at affiliate service delivery points. The IPES includes HIV testing, HIV prevention, HIV care and treatment, services for sexually transmitted infections and reproductive tract infections, contraception, abortion care, obstetrics and gynaecology, fertility support, and support for sexual and gender-based violence Purpose The purpose of our HIV Theory of Change is to clarify the goals and vision of IPPF’s HIV programme and to articulate the different pathways and strategies IPPF uses to contribute towards its HIV goals and vision. This Theory of Change endeavours to represent a conceptual model that is complex and non-linear in the format of a readable diagram. Therefore, this Theory of Change diagram is a simplified representation of a complex process which cannot be fully captured in this format. Our Theory of Change describes causal pathways for how the work in our HIV programme contributes to the ultimate goals and vision. The purpose of this conceptual model is not to provide a detailed description of the components of our HIV services, as these are described in the 2020 ‘IPPF Comprehensive HIV Services Package’ and the IPPF 2022 ‘Client-centred-clinical guidelines for sexual and reproductive health care’. Reading the diagram Our Theory of Change diagram is read from left to right, representing movement in time from the world we currently live in (left side) towards the future we would like to see, which is represented by our vision (right side). There are 7 pathways (page 1), each with a set of strategies (shown on pages 4 and 5 as close-ups of the diagram), whose work contributes towards achieving our HIV goals and vision. The 7 pathways are divided into cross-cutting pathways (community engagement, evidence and learning, capacity strengthening and sharing, strategic partnership building) and core pathways (advocacy, empowerment, comprehensive service delivery). The cross-cutting pathways are iterative and intersecting, contributing to each other and collectively contributing to the 3 core pathways. The core pathways represent the 3 main areas of our HIV programme, which, like all elements of the diagram, also interact with each other synergistically. The strategies of all 7 pathways working together contribute towards a set of outcomes. The outcomes interacting together contribute towards our goals, which in turn interact with each other, and contribute towards our ultimate vision.

rajah-outreach-team
13 September 2023

Championing Change: A Community-Led Approach to HIV Services in the Philippines

Located in the bustling heart of Iloilo City is the RAJAH Community Centre, a dynamic hub with a meaningful mission. RAJAH stands for "Raising Awareness for Junior Advocates on HIV." Established in 2019 by the Family Planning Organization of the Philippines (FPOP), this centre provides a safe space for HIV testing and support services, free from stigma.  The centre provides counselling and a range of supportive initiatives tailored to its diverse community. What sets this centre apart from other HIV diagnostic and treatment facilities is its unique operational model, primarily driven by volunteers. Many of these volunteers are part of the LGBTIQ+ communities they serve.  Mona Liza S. Diones, the Chapter Program Manager of FPOP Iloilo, noted that a significant number of potential clients still hesitate due to fears associated with visiting a treatment facility. “At RAJAH, we're working to change this perception by providing essential services that promote comfort and eliminate prejudice.”  The centre is a crucial service point that complements existing facilities run by local government units. In partnership with the Department of Health, it provides continuous HIV services, including telemedicine, mobile clinics, and the distribution of essential items such as PrEP (Pre-Exposure Prophylaxis) and condoms. PrEP is an oral pill that reduces the risk of contracting HIV from sex by about 99% when taken correctly. Onsite HIV testing is available for individuals aged 15 and above, following the guidelines of the HIV and AIDS Policy Act in the Philippines, which allows those between 15 to 18 to access testing without parental or guardian consent.  As of January 2023, the Philippines recorded 110,736 cases of HIV. The number of people with HIV is projected to rise by 200%, from 158,400 in 2022 to 364,000 by 2030. 

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IMAP Statement on Biomedical HIV Prevention

Recent advances in biomedical HIV prevention technologies mean more choices are available for people to protect themselves from HIV. Therefore, these technologies must be effectively made available and affordable to all populations who need them. All individuals have a right to sexual and reproductive health, and HIV prevention is a key component necessary to ensure health, well-being, positive sexual lives and the upholding of human rights. Access to these new technologies is a key to successfully meeting the Sustainable Development Goal 3.3: ending the AIDS epidemic by 2030. This IMAP Statement is intended to update Member Associations across the Federation on biomedical HIV prevention technologies and support their integration of new biomedical HIV prevention services into comprehensive sexual and reproductive health service delivery. Download the statement in English, Spanish, French and Arabic below.

hiv-prevention-technologies
18 May 2023

Innovations in HIV prevention technologies spark hope

In the 42 years since AIDS was first discovered in 1981, extraordinary progress has been made in the global response to HIV. Deaths caused by acquired immunodeficiency syndrome (AIDS) - a condition caused by the human immunodeficiency virus (HIV) - have been reduced by 68% since the peak in 2004. Despite the disruption caused by the COVID-19 pandemic, volunteers, community members, health professionals, and scientists around the world have rallied together in the pursuit of a safe and effective HIV vaccine. This could have a tremendous impact in helping to control the HIV pandemic, improve public health and equity, and pave the way for the development of other vaccines globally.  In the meantime, improvements in treatment options have helped ensure people with HIV can live long and productive lives. New technologies to prevent HIV transmission also mean people have more options for pleasurable sex with reduced risk of acquiring HIV.   But there is still a long way to go. In recent years, global progress towards eliminating HIV has slowed and funding has decreased. In 2021, 1.5 million new people were diagnosed with HIV; a total of 38.4 million people currently live with HIV globally.  Fortunately, important innovations in HIV prevention technologies have sparked hope that the global AIDS response can get closer to its targets for ending the pandemic. We need to increase access and affordability to these technologies while continuing to invest in new ways to prevent transmission, expand testing, and treat patients.  HIV prevention technologies to know about  In addition to the condom, which reduces transmission of HIV and many other sexually transmitted infections, and prevents pregnancy, we now have multiple ways to prevent HIV transmission.  Prevention of Perinatal Transmission uses Antiretroviral drugs (ARVs) to reduce transmission from a woman with HIV to her fetus during pregnancy, and from a woman to her infant during childbirth and breastfeeding.  Post-exposure prophylaxis (PEP) uses ARVs to reduce transmission when someone without HIV has had a possible exposure to HIV. PEP should be used in emergency situations and be started within 72 hours after a recent possible exposure to HIV.  Voluntary medical male circumcision (VMMC) is used to reduce heterosexual transmission in men who do not have HIV.   A variety of new and existing forms of Pre-exposure prophylaxis (PrEP) also need to be made available, accessible, and affordable to all.   Oral PrEP uses ARVs to help people who do not have HIV reduce their risk of acquiring HIV. PrEP was first recommended by the WHO in 2012. While over 3 million people have initiated oral PrEP globally since then, many more people need access to this highly effective method of HIV prevention.   Dapivirine Vaginal Ring is a ring that is placed in the vagina and contains ARVs to reduce sexual transmission of HIV for women. The ARVs are slowly released over the course of a month; a new ring is inserted for each month that a woman wants to reduce her risk of acquiring HIV. It was recommended by the WHO in January 2021 and has received regulatory approval in Lesotho, South Africa and Zimbabwe. It is currently under regulatory review in Botswana, Kenya, Malawi, Namibia, Rwanda, Tanzania, Uganda, and Zambia. Long-acting Injectable PrEP using Cabotegravir-LA is a new form of PrEP that is injected intramuscularly every two months to prevent HIV. It was recommended by the WHO in 2022 and has received regulatory approval in Australia, the United States, and Zimbabwe. It is currently under regulatory review in Botswana, Brazil, Kenya, Malawi, Namibia, Rwanda, South Africa, and Uganda.  Equalizing access for all  Adolescent girls and women account for 49% of new infections globally and 63% of new infections in sub-Saharan Africa. It is essential that we reach them and key populations -- including gay men, men who have sex with men, transgender people, people who use drugs, sex workers, and prisoners – and their partners -- with new and existing prevention technologies by making them more widely available, accessible and affordable.  In addition to improving global HIV prevention response, we must eliminate barriers including stigma, discriminatory laws, denial of sexual and reproductive health and rights, criminalization, and punitive approaches that cause harm and negatively impact people’s sexual and reproductive health and rights. We must also encourage supportive policies for HIV self-testing, and we must invest in and expand access to innovative prevention and treatment options such as long-acting injectable PrEP and long-acting injectable treatment.  All individuals have a right to make decisions about their bodies and to access the services they need to live a healthy and productive life. IPPF, through its member associations (MAs), is committed to offering all clients integrated sexual and reproductive health services, in a welcoming, inclusive, and non-discriminatory environment. As part of our new 2028 Strategy: Come Together, we outline the importance of accelerating integration of HIV and SRHR care.  Investments in developing and rolling out new technologies that protect against pregnancy and HIV, such as the Dual Prevention pill, are key to reducing HIV globally.   IPPF and our MAs will continue to join forces with technical experts and community and youth-led organizations working at every level of society — globally, nationally, and locally – to eradicate AIDS for good.   

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Technical Brief: Fulfilling the sexual and reproductive rights of women living with HIV, preventing coerced and forced sterilization

The purpose of this technical brief is to promote gender-transformative, rights-based and scientifically accurate information for advocacy and service-delivery to fulfil the sexual and reproductive rights of women, girls and people who have the capacity to become pregnant, who are living with HIV.  In doing so, we also aim to provide sufficient evidence to prevent sexual and reproductive rights violations, especially coerced and/or forced sterilization against those living with HIV. The technical brief documents that coerced and/or forced sterilization of women living with HIV is a persistent and serious human rights violation requiring urgent action. The brief reviews components of comprehensive sexual and reproductive health (SRH) service delivery and international medical guidance to uphold and fulfil the sexual and reproductive health and rights of women living with HIV to choose if and when to have children.  This brief is primarily intended to inform IPPF Member Associations, secretariat staff, and partners including other SRH service delivery organizations and stakeholders. The brief reinforces IPPF’s position and commitment to person-centred and rights-based HIV care that is integrated within a comprehensive package of SRH services. Download the technical brief below in English or Spanish. 

Illustration of STIs
03 September 2021

STIs: Hepatitis

Hepatitis is the medical term for inflammation of the liver. Hepatitis can be caused by liver damage by drinking alcohol or through viral infections which and can be transmitted through sexual activity.   There are various types of viral hepatitis, but only hepatitis A, B, and C can be transmitted through unprotected sexual activity. Hepatitis A virus can be passed on through unprotected anal or oral sex as it is present in the poo of an infected person. The hepatitis B virus is found in the blood and bodily fluids such as semen and vaginal fluids of an infected person and can be passed on during unprotected vaginal, anal, and oral sex, pregnancy, and sharing needles to inject drugs. The hepatitis C virus is mostly transmitted through the blood of an infected person, with sexual transmission possible, but not common.  Symptoms   It can be common for hepatitis to have no noticeable symptoms, so you may not be aware that you have it. However, early signs can include flu-like symptoms such as:  Muscle and joint pain   Headaches  Feeling sick  High temperature   Feeling tired   Jaundice (yellowing of the skin and eyes)  Some types of hepatitis can pass without affecting the liver, while others may become chronic lasting for years or may cause cirrhosis (scarring of the liver). Chronic hepatitis symptoms include:   Constant tiredness  Jaundice  Depression   Generally feeling unwell  Testing   To test for hepatitis a healthcare provider will take a blood sample to test that will indicate if your immune system is trying to fight the virus. Your liver function may also be tested through an ultrasound scan or a liver biopsy (a sample of liver tissue is collected for testing).   If you test positive for hepatitis your healthcare provider may prescribe antiviral medication. If your test is positive for hepatitis C you will be referred to a specialist for treatment options. Treatment can be more effective the sooner it is started.   Treatment   For many types of hepatitis there is no treatment, however symptoms can be managed with antiviral medication or painkillers such as ibuprofen. Resting and staying hydrated are important, especially resting the liver by avoiding drinking alcohol.   It's important that your current sexual partner and any other recent sexual partners you have had are also tested and treated.  Prevention  There are several ways to reduce the risk of infection and protect yourself and your sexual partners from hepatitis. Hepatitis A and B can be prevented by vaccination, but not hepatitis C. Often a combined vaccine for hepatitis A and B is available, however recommended vaccination differs country-by-country. When used correctly and consistently, condoms are one of the most effective methods of protection against hepatitis and other STIs.  Learn more about different types of STIs and their symptoms, treatment, and prevention

Illustration of STIs
02 September 2021

STIs: HIV (Human Immunodeficiency Virus)

Human Immunodeficiency Virus (commonly known as HIV) is a virus that damages the body’s immune system so it cannot fight off infections. It is preventable and treatable, but not curable. Anyone can get and transmit HIV.   HIV lives in the blood and some bodily fluids (semen, including pre-cum, and vaginal fluids). HIV can be transmitted through:  Vaginal or anal sex without a condom  Oral sex without a condom (although this is rare)  Sharing sex toys without washing them or covering them with a condom with each use  Use of unsterile injecting equipment   If you are living with HIV, it can also be transmitted during pregnancy, childbirth or breastfeeding.   Bodily fluids such as urine, sweat or saliva do not contain enough of the virus to infect another person. You cannot get HIV from casual contact such as kissing or hugging.  Acquired Immune Deficiency Syndrome (commonly known as AIDS) is an advanced stage of HIV infection, when your immune system is damaged and weakens your ability to fight common infections. However, with early diagnosis and effective treatment, most people with HIV will not develop AIDS.  Symptoms   Most people with HIV will experience signs seroconversion, a short, two-week illness soon after getting the virus. Seroconversion can feel like a flu (with sore throat, fever, tiredness, achy joints, swollen glands and a rash), and in some cases it could be severe enough to put you in hospital. However, a small number of people will not experience any noticeable signs or symptoms.   After seroconversion, a person with HIV may not have symptoms for many years and might look and feel well, but the virus will be multiplying in their body, causing progressive weakening of the immune system. Following this period, symptoms may include weight loss, persistent diarrhoea, night sweats, and infections that keep returning.  Testing   The earlier that someone with HIV gets a diagnosis, the more likely it can be treated so it is important to get tested if you think you may have been exposed to HIV. Delaying testing and treatment will allow the virus to weaken your immune system. It also means you could pass the virus to someone else.  HIV can’t be tested until at least four weeks after exposure to the virus, with more accurate results if the test is done six weeks after exposure to the virus. However, most tests do not detect the virus itself but the antibodies that your body has developed to fight it and are most accurate after twelve weeks.  Testing for HIV involves taking a small sample of blood for analysis. The test is either sent away to a laboratory and results come back in a few days, or same-day tests can give an instant result. It is also possible to test a saliva sample or to test blood taken from pricking the finger.   In some places, you may be able to do the test by yourself in the privacy of your home or another convenient place. If the test is ‘reactive’, you will need to visit a healthcare provider for further testing to confirm whether you have HIV and require treatment.   Treatment   It is recommended that all people with HIV start treatment as soon as possible after diagnosis. In some places, you may receive regular blood tests to check how your immune system is coping and will only recommend treatment if the cells in your blood that fight infection have dropped below a certain level.  The treatment helps to manage the balance between the levels of HIV in your blood and the infection-fighting cells that your immune system has produced to fight it. It is treated with drugs called antiretrovirals – they work by stopping the HIV multiplying, allowing the immune system a chance to repair itself.  A combination of antiretrovirals is used because HIV can quickly adapt and become resistant to them. The combination that is most effective will be unique to each person. These drugs will suppress the amount of virus in the body, stop the progression of infection, and prevent transmission of HIV to others.  Prevention  There are several ways to reduce the risk of infection and protect yourself and your sexual partners from HIV. When used correctly and consistently, condoms are one of the most effective methods of protection against HIV and other STIs.   There is also a medicine called PrEP (pre-exposure prophylaxis) for people who do not have HIV. PrEP is taken before sex and can reduce the risk of HIV transmission when it is taken correctly. PrEP can be used as a way to reduce your risk of HIV if you are HIV negative and don’t always use condoms.  It is important to remember that PrEP will not protect you from other STIs, and you should wear a condom every time you have sex (whether it is anal, oral or vaginal).  If you think you may have already been exposed to HIV within the last 72 hours (three days), it is also possible to take anti-HIV medication called PEP (post-exposure prophylaxis) which may stop you becoming infected.  PEP is a 28-day treatment of powerful drugs and is not guaranteed to work. It is often recommended if you are at high-risk of exposure (for example, if a partner is known to be HIV positive).  It's also a good idea to get tested before each new sexual partner or every three to six months.  Learn more about different types of STIs and their symptoms, treatment, and prevention

Illustration of STIs
02 September 2021

STIs: Genital warts

Genital warts are caused by the human papillomavirus (HPV) and are small growths or bumps that appear on or around the genital or anal area.  There are over 100 different types of HPV which can affect different parts of the body. About 30 different types of HPV can affect the genital skin, but 90% of genital warts are caused by two types of the virus – types 6 and 11.  The most common way for HPV to be passed on is through skin-to-skin contact with someone who has the virus. Genital warts can be passed on even if they are not visible. Most commonly, this is through sexual activity, such as vaginal, anal and oral sex, non-penetrative genital-to-genital contact, and sharing sex toys.   HPV is not passed on by casual contact such as kissing or hugging.  Symptoms  Genital warts are normally painless but, in some people, they can be itchy and become inflamed, which may cause a little bleeding. They can either appear on their own or in clusters. The most common places for them to appear are:  Around the opening of the vagina (vulva)  Around the cervix (the neck of the womb)  Inside the vagina  Around or inside the anus  On the upper thighs  Anywhere on the penis  On the scrotum  Inside the urethra (where urine comes out) in people with a penis   Testing If you suspect you or a sexual partner have genital warts, see your healthcare provider for a medical examination. Testing is usually not required for genital warts, but it is easy for a healthcare provider to diagnose by examining the area. In some cases, they may need to perform a more detailed examination in order to see if there are warts inside the vagina or anus.  Treatment    If you have visible genital warts, the two main types of treatment are:  applying cream or lotion to the warts  destroying the tissue of the warts by freezing, heating or removing them  Unfortunately, wart creams that are available over the counter will not be effective as because they are designed to only treat warts on the hands or verrucas.   The type of treatment you are offered depends on the warts. You should tell the healthcare provider if you are pregnant or if there is a risk of pregnancy as this may affect the type of treatment they are offered.  For some people it can take months for the treatment to work and for the warts to disappear.  It is recommended that you avoid having sex until your genital warts have fully healed. Not only will this help to ensure you don’t pass it on to others, but it may also help you recover more quickly.  Over time, genital warts will go away without treatment but if left untreated, they may also grow larger or multiply. They are rarely harmful to your health, but genital warts can be unpleasant and may cause discomfort.  Prevention   When used correctly and consistently, condoms can help protect you from HPV but may still be passed on by the surrounding genital areas coming into contact with the virus.  The HPV vaccine can protect against genital warts and types of HPV that can cause cancer, so it is worth checking if you are eligible to receive this.  Learn more about different types of STIs and their symptoms, treatment, and prevention

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IMAP Statement on Person-centred Care for Sexually Transmitted Infections

Recognizing the significant global impact of sexually transmitted infections (STIs), this statement affirms IPPF’s commitment to people-centred STI care as a critical aspect of comprehensive sexual and reproductive health and well-being. A holistic approach to sexual and reproductive health and rights acknowledges that true sexual and reproductive well-being extends beyond the prevention and treatment of diseases. It emphasizes the importance of promoting healthy, satisfying sexual and reproductive experiences. This includes advocating for personcentred care, encouraging self-care strategies, and supporting the development of innovative healthcare delivery models tailored to meet the diverse needs of individuals in various circumstances and contexts, particularly reaching those who are often excluded and marginalized. This statement updates the latest information on STIs. It provides practical recommendations for IPPF Member Associations on how to develop a comprehensive, people-centred approach to STI care, emphasizing integrated services, adherence to guidelines, rights-based care, community engagement, advocacy, and a positive perspective on sexual health and well-being.

lesotho-hiv
01 December 2023

Step on the Red Carpet: Lesotho’s Youth Receiving Premium SRHR Services through IPPF’s Member Association

Lesotho, a country situated in Southern Africa and landlocked by the Republic of South Africa, has an estimated total population of 2.1 million people. The small country is still heavily affected by HIV and AIDS, with high prevalence rates of 24.3% among women aged 15-49, and 14.2% among men in the same age bracket. The Lesotho government, in partnership with various non-governmental organizations, continues to address these alarming rates, including among adolescents and youth. One of the government’s key partners in the country is IPPF’s Member Association in Lesotho, Lesotho Planned Parenthood Association (LPPA). One of LPPA’s strategy aimed at increasing HIV linkage and retention in care and treatment among adolescents and young people living with HIV, is through an initiative known as the ‘Red-Carpet model’. The initiative, started in May 2023, is being piloted in LPPA’s youth clinic located in the capital city, Maseru. The ‘Red-Carpet model’ is aimed at providing adolescents and young people with a VIP experience as they access quality youth-friendly services at the facility. The model fast tracks services and reduces barriers for adolescents to access and utilize integrated HIV/SRH services. We had a chat with Ms. Mamojela Koneshe, LPPA’s Executive Director, who sheds more light on this initiative. How exactly does the ‘Red-Carpet’ model work? The model serves all adolescents and young people who visit the clinic, regardless of if they are first time or returning clients. For the new clients, they first report to the reception area upon arrival at the clinic. They are then referred to the waiting area where an LPPA Youth Ambassador gives them information about the model, how it works and its benefits. Youth Ambassadors are young people seconded to LPPA clinics by one of our partner organizations - Elizabeth Glaser Paediatric AIDS Foundation (EGPAF). Their duties include ensuring that adolescents in the clinic are linked to appropriate HIV prevention methods and treatment. They also hold scheduled peer support groups, and in collaboration with the Youth Nurse, link vulnerable youth to various organisations depending on their needs –for example linking sexual and gender-based violence survivors to shelters. The Youth Ambassadors also ensure that red carpet model is well implemented. While at the waiting area, the Youth Ambassador gives the adolescent or young client access to free wi-fi, which enables them to access the internet. After this, the client is enrolled in the model and given a VIP card. When their turn arrives, the Youth Ambassador escorts them to the relevant consultation or counselling room depending on the service they need. The expected time spent in the facility by the young person is 45minutes. This is the maximum time expected to be spent by young people while accessing services and was informed by the various services that young people access in our facility. Telephone follow-up interviews are then done with the clients on a weekly basis. On their return visit, upon arrival at the facility, adolescents report to the reception where they present the VIP card they were given at their first visit. They are then referred to the waiting area where once again, the Youth Ambassador gives them a free wi-fi voucher and links them to the appropriate service. Similarly, the expected time spent in the facility is 45minutes. Why is the provision of free internet to adolescents and youth at the clinic important? This is because it enables young people to access a vast amount of health information online. By connecting to the internet, they search for health-related information. It also gives them access to educational resources that can help them make informed decisions about their health. Going online also helps them to connect with their peers within established peer support groups. In addition, most of our clients are students at colleges, universities, and other learning institutions, so facilitating their free internet access helps them to continue studying and researching while waiting for services. They like this since they don’t have to use their own internet bundles, which can be quite expensive for them.

HIV

HIV Theory of Change

Background IPPF offers a comprehensive approach to sexual and reproductive health and rights through its Integrated Package of Essential Services (IPES) which is offered at affiliate service delivery points. The IPES includes HIV testing, HIV prevention, HIV care and treatment, services for sexually transmitted infections and reproductive tract infections, contraception, abortion care, obstetrics and gynaecology, fertility support, and support for sexual and gender-based violence Purpose The purpose of our HIV Theory of Change is to clarify the goals and vision of IPPF’s HIV programme and to articulate the different pathways and strategies IPPF uses to contribute towards its HIV goals and vision. This Theory of Change endeavours to represent a conceptual model that is complex and non-linear in the format of a readable diagram. Therefore, this Theory of Change diagram is a simplified representation of a complex process which cannot be fully captured in this format. Our Theory of Change describes causal pathways for how the work in our HIV programme contributes to the ultimate goals and vision. The purpose of this conceptual model is not to provide a detailed description of the components of our HIV services, as these are described in the 2020 ‘IPPF Comprehensive HIV Services Package’ and the IPPF 2022 ‘Client-centred-clinical guidelines for sexual and reproductive health care’. Reading the diagram Our Theory of Change diagram is read from left to right, representing movement in time from the world we currently live in (left side) towards the future we would like to see, which is represented by our vision (right side). There are 7 pathways (page 1), each with a set of strategies (shown on pages 4 and 5 as close-ups of the diagram), whose work contributes towards achieving our HIV goals and vision. The 7 pathways are divided into cross-cutting pathways (community engagement, evidence and learning, capacity strengthening and sharing, strategic partnership building) and core pathways (advocacy, empowerment, comprehensive service delivery). The cross-cutting pathways are iterative and intersecting, contributing to each other and collectively contributing to the 3 core pathways. The core pathways represent the 3 main areas of our HIV programme, which, like all elements of the diagram, also interact with each other synergistically. The strategies of all 7 pathways working together contribute towards a set of outcomes. The outcomes interacting together contribute towards our goals, which in turn interact with each other, and contribute towards our ultimate vision.

rajah-outreach-team
13 September 2023

Championing Change: A Community-Led Approach to HIV Services in the Philippines

Located in the bustling heart of Iloilo City is the RAJAH Community Centre, a dynamic hub with a meaningful mission. RAJAH stands for "Raising Awareness for Junior Advocates on HIV." Established in 2019 by the Family Planning Organization of the Philippines (FPOP), this centre provides a safe space for HIV testing and support services, free from stigma.  The centre provides counselling and a range of supportive initiatives tailored to its diverse community. What sets this centre apart from other HIV diagnostic and treatment facilities is its unique operational model, primarily driven by volunteers. Many of these volunteers are part of the LGBTIQ+ communities they serve.  Mona Liza S. Diones, the Chapter Program Manager of FPOP Iloilo, noted that a significant number of potential clients still hesitate due to fears associated with visiting a treatment facility. “At RAJAH, we're working to change this perception by providing essential services that promote comfort and eliminate prejudice.”  The centre is a crucial service point that complements existing facilities run by local government units. In partnership with the Department of Health, it provides continuous HIV services, including telemedicine, mobile clinics, and the distribution of essential items such as PrEP (Pre-Exposure Prophylaxis) and condoms. PrEP is an oral pill that reduces the risk of contracting HIV from sex by about 99% when taken correctly. Onsite HIV testing is available for individuals aged 15 and above, following the guidelines of the HIV and AIDS Policy Act in the Philippines, which allows those between 15 to 18 to access testing without parental or guardian consent.  As of January 2023, the Philippines recorded 110,736 cases of HIV. The number of people with HIV is projected to rise by 200%, from 158,400 in 2022 to 364,000 by 2030. 

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IMAP Statement on Biomedical HIV Prevention

Recent advances in biomedical HIV prevention technologies mean more choices are available for people to protect themselves from HIV. Therefore, these technologies must be effectively made available and affordable to all populations who need them. All individuals have a right to sexual and reproductive health, and HIV prevention is a key component necessary to ensure health, well-being, positive sexual lives and the upholding of human rights. Access to these new technologies is a key to successfully meeting the Sustainable Development Goal 3.3: ending the AIDS epidemic by 2030. This IMAP Statement is intended to update Member Associations across the Federation on biomedical HIV prevention technologies and support their integration of new biomedical HIV prevention services into comprehensive sexual and reproductive health service delivery. Download the statement in English, Spanish, French and Arabic below.

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18 May 2023

Innovations in HIV prevention technologies spark hope

In the 42 years since AIDS was first discovered in 1981, extraordinary progress has been made in the global response to HIV. Deaths caused by acquired immunodeficiency syndrome (AIDS) - a condition caused by the human immunodeficiency virus (HIV) - have been reduced by 68% since the peak in 2004. Despite the disruption caused by the COVID-19 pandemic, volunteers, community members, health professionals, and scientists around the world have rallied together in the pursuit of a safe and effective HIV vaccine. This could have a tremendous impact in helping to control the HIV pandemic, improve public health and equity, and pave the way for the development of other vaccines globally.  In the meantime, improvements in treatment options have helped ensure people with HIV can live long and productive lives. New technologies to prevent HIV transmission also mean people have more options for pleasurable sex with reduced risk of acquiring HIV.   But there is still a long way to go. In recent years, global progress towards eliminating HIV has slowed and funding has decreased. In 2021, 1.5 million new people were diagnosed with HIV; a total of 38.4 million people currently live with HIV globally.  Fortunately, important innovations in HIV prevention technologies have sparked hope that the global AIDS response can get closer to its targets for ending the pandemic. We need to increase access and affordability to these technologies while continuing to invest in new ways to prevent transmission, expand testing, and treat patients.  HIV prevention technologies to know about  In addition to the condom, which reduces transmission of HIV and many other sexually transmitted infections, and prevents pregnancy, we now have multiple ways to prevent HIV transmission.  Prevention of Perinatal Transmission uses Antiretroviral drugs (ARVs) to reduce transmission from a woman with HIV to her fetus during pregnancy, and from a woman to her infant during childbirth and breastfeeding.  Post-exposure prophylaxis (PEP) uses ARVs to reduce transmission when someone without HIV has had a possible exposure to HIV. PEP should be used in emergency situations and be started within 72 hours after a recent possible exposure to HIV.  Voluntary medical male circumcision (VMMC) is used to reduce heterosexual transmission in men who do not have HIV.   A variety of new and existing forms of Pre-exposure prophylaxis (PrEP) also need to be made available, accessible, and affordable to all.   Oral PrEP uses ARVs to help people who do not have HIV reduce their risk of acquiring HIV. PrEP was first recommended by the WHO in 2012. While over 3 million people have initiated oral PrEP globally since then, many more people need access to this highly effective method of HIV prevention.   Dapivirine Vaginal Ring is a ring that is placed in the vagina and contains ARVs to reduce sexual transmission of HIV for women. The ARVs are slowly released over the course of a month; a new ring is inserted for each month that a woman wants to reduce her risk of acquiring HIV. It was recommended by the WHO in January 2021 and has received regulatory approval in Lesotho, South Africa and Zimbabwe. It is currently under regulatory review in Botswana, Kenya, Malawi, Namibia, Rwanda, Tanzania, Uganda, and Zambia. Long-acting Injectable PrEP using Cabotegravir-LA is a new form of PrEP that is injected intramuscularly every two months to prevent HIV. It was recommended by the WHO in 2022 and has received regulatory approval in Australia, the United States, and Zimbabwe. It is currently under regulatory review in Botswana, Brazil, Kenya, Malawi, Namibia, Rwanda, South Africa, and Uganda.  Equalizing access for all  Adolescent girls and women account for 49% of new infections globally and 63% of new infections in sub-Saharan Africa. It is essential that we reach them and key populations -- including gay men, men who have sex with men, transgender people, people who use drugs, sex workers, and prisoners – and their partners -- with new and existing prevention technologies by making them more widely available, accessible and affordable.  In addition to improving global HIV prevention response, we must eliminate barriers including stigma, discriminatory laws, denial of sexual and reproductive health and rights, criminalization, and punitive approaches that cause harm and negatively impact people’s sexual and reproductive health and rights. We must also encourage supportive policies for HIV self-testing, and we must invest in and expand access to innovative prevention and treatment options such as long-acting injectable PrEP and long-acting injectable treatment.  All individuals have a right to make decisions about their bodies and to access the services they need to live a healthy and productive life. IPPF, through its member associations (MAs), is committed to offering all clients integrated sexual and reproductive health services, in a welcoming, inclusive, and non-discriminatory environment. As part of our new 2028 Strategy: Come Together, we outline the importance of accelerating integration of HIV and SRHR care.  Investments in developing and rolling out new technologies that protect against pregnancy and HIV, such as the Dual Prevention pill, are key to reducing HIV globally.   IPPF and our MAs will continue to join forces with technical experts and community and youth-led organizations working at every level of society — globally, nationally, and locally – to eradicate AIDS for good.   

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Technical Brief: Fulfilling the sexual and reproductive rights of women living with HIV, preventing coerced and forced sterilization

The purpose of this technical brief is to promote gender-transformative, rights-based and scientifically accurate information for advocacy and service-delivery to fulfil the sexual and reproductive rights of women, girls and people who have the capacity to become pregnant, who are living with HIV.  In doing so, we also aim to provide sufficient evidence to prevent sexual and reproductive rights violations, especially coerced and/or forced sterilization against those living with HIV. The technical brief documents that coerced and/or forced sterilization of women living with HIV is a persistent and serious human rights violation requiring urgent action. The brief reviews components of comprehensive sexual and reproductive health (SRH) service delivery and international medical guidance to uphold and fulfil the sexual and reproductive health and rights of women living with HIV to choose if and when to have children.  This brief is primarily intended to inform IPPF Member Associations, secretariat staff, and partners including other SRH service delivery organizations and stakeholders. The brief reinforces IPPF’s position and commitment to person-centred and rights-based HIV care that is integrated within a comprehensive package of SRH services. Download the technical brief below in English or Spanish. 

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03 September 2021

STIs: Hepatitis

Hepatitis is the medical term for inflammation of the liver. Hepatitis can be caused by liver damage by drinking alcohol or through viral infections which and can be transmitted through sexual activity.   There are various types of viral hepatitis, but only hepatitis A, B, and C can be transmitted through unprotected sexual activity. Hepatitis A virus can be passed on through unprotected anal or oral sex as it is present in the poo of an infected person. The hepatitis B virus is found in the blood and bodily fluids such as semen and vaginal fluids of an infected person and can be passed on during unprotected vaginal, anal, and oral sex, pregnancy, and sharing needles to inject drugs. The hepatitis C virus is mostly transmitted through the blood of an infected person, with sexual transmission possible, but not common.  Symptoms   It can be common for hepatitis to have no noticeable symptoms, so you may not be aware that you have it. However, early signs can include flu-like symptoms such as:  Muscle and joint pain   Headaches  Feeling sick  High temperature   Feeling tired   Jaundice (yellowing of the skin and eyes)  Some types of hepatitis can pass without affecting the liver, while others may become chronic lasting for years or may cause cirrhosis (scarring of the liver). Chronic hepatitis symptoms include:   Constant tiredness  Jaundice  Depression   Generally feeling unwell  Testing   To test for hepatitis a healthcare provider will take a blood sample to test that will indicate if your immune system is trying to fight the virus. Your liver function may also be tested through an ultrasound scan or a liver biopsy (a sample of liver tissue is collected for testing).   If you test positive for hepatitis your healthcare provider may prescribe antiviral medication. If your test is positive for hepatitis C you will be referred to a specialist for treatment options. Treatment can be more effective the sooner it is started.   Treatment   For many types of hepatitis there is no treatment, however symptoms can be managed with antiviral medication or painkillers such as ibuprofen. Resting and staying hydrated are important, especially resting the liver by avoiding drinking alcohol.   It's important that your current sexual partner and any other recent sexual partners you have had are also tested and treated.  Prevention  There are several ways to reduce the risk of infection and protect yourself and your sexual partners from hepatitis. Hepatitis A and B can be prevented by vaccination, but not hepatitis C. Often a combined vaccine for hepatitis A and B is available, however recommended vaccination differs country-by-country. When used correctly and consistently, condoms are one of the most effective methods of protection against hepatitis and other STIs.  Learn more about different types of STIs and their symptoms, treatment, and prevention

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02 September 2021

STIs: HIV (Human Immunodeficiency Virus)

Human Immunodeficiency Virus (commonly known as HIV) is a virus that damages the body’s immune system so it cannot fight off infections. It is preventable and treatable, but not curable. Anyone can get and transmit HIV.   HIV lives in the blood and some bodily fluids (semen, including pre-cum, and vaginal fluids). HIV can be transmitted through:  Vaginal or anal sex without a condom  Oral sex without a condom (although this is rare)  Sharing sex toys without washing them or covering them with a condom with each use  Use of unsterile injecting equipment   If you are living with HIV, it can also be transmitted during pregnancy, childbirth or breastfeeding.   Bodily fluids such as urine, sweat or saliva do not contain enough of the virus to infect another person. You cannot get HIV from casual contact such as kissing or hugging.  Acquired Immune Deficiency Syndrome (commonly known as AIDS) is an advanced stage of HIV infection, when your immune system is damaged and weakens your ability to fight common infections. However, with early diagnosis and effective treatment, most people with HIV will not develop AIDS.  Symptoms   Most people with HIV will experience signs seroconversion, a short, two-week illness soon after getting the virus. Seroconversion can feel like a flu (with sore throat, fever, tiredness, achy joints, swollen glands and a rash), and in some cases it could be severe enough to put you in hospital. However, a small number of people will not experience any noticeable signs or symptoms.   After seroconversion, a person with HIV may not have symptoms for many years and might look and feel well, but the virus will be multiplying in their body, causing progressive weakening of the immune system. Following this period, symptoms may include weight loss, persistent diarrhoea, night sweats, and infections that keep returning.  Testing   The earlier that someone with HIV gets a diagnosis, the more likely it can be treated so it is important to get tested if you think you may have been exposed to HIV. Delaying testing and treatment will allow the virus to weaken your immune system. It also means you could pass the virus to someone else.  HIV can’t be tested until at least four weeks after exposure to the virus, with more accurate results if the test is done six weeks after exposure to the virus. However, most tests do not detect the virus itself but the antibodies that your body has developed to fight it and are most accurate after twelve weeks.  Testing for HIV involves taking a small sample of blood for analysis. The test is either sent away to a laboratory and results come back in a few days, or same-day tests can give an instant result. It is also possible to test a saliva sample or to test blood taken from pricking the finger.   In some places, you may be able to do the test by yourself in the privacy of your home or another convenient place. If the test is ‘reactive’, you will need to visit a healthcare provider for further testing to confirm whether you have HIV and require treatment.   Treatment   It is recommended that all people with HIV start treatment as soon as possible after diagnosis. In some places, you may receive regular blood tests to check how your immune system is coping and will only recommend treatment if the cells in your blood that fight infection have dropped below a certain level.  The treatment helps to manage the balance between the levels of HIV in your blood and the infection-fighting cells that your immune system has produced to fight it. It is treated with drugs called antiretrovirals – they work by stopping the HIV multiplying, allowing the immune system a chance to repair itself.  A combination of antiretrovirals is used because HIV can quickly adapt and become resistant to them. The combination that is most effective will be unique to each person. These drugs will suppress the amount of virus in the body, stop the progression of infection, and prevent transmission of HIV to others.  Prevention  There are several ways to reduce the risk of infection and protect yourself and your sexual partners from HIV. When used correctly and consistently, condoms are one of the most effective methods of protection against HIV and other STIs.   There is also a medicine called PrEP (pre-exposure prophylaxis) for people who do not have HIV. PrEP is taken before sex and can reduce the risk of HIV transmission when it is taken correctly. PrEP can be used as a way to reduce your risk of HIV if you are HIV negative and don’t always use condoms.  It is important to remember that PrEP will not protect you from other STIs, and you should wear a condom every time you have sex (whether it is anal, oral or vaginal).  If you think you may have already been exposed to HIV within the last 72 hours (three days), it is also possible to take anti-HIV medication called PEP (post-exposure prophylaxis) which may stop you becoming infected.  PEP is a 28-day treatment of powerful drugs and is not guaranteed to work. It is often recommended if you are at high-risk of exposure (for example, if a partner is known to be HIV positive).  It's also a good idea to get tested before each new sexual partner or every three to six months.  Learn more about different types of STIs and their symptoms, treatment, and prevention

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02 September 2021

STIs: Genital warts

Genital warts are caused by the human papillomavirus (HPV) and are small growths or bumps that appear on or around the genital or anal area.  There are over 100 different types of HPV which can affect different parts of the body. About 30 different types of HPV can affect the genital skin, but 90% of genital warts are caused by two types of the virus – types 6 and 11.  The most common way for HPV to be passed on is through skin-to-skin contact with someone who has the virus. Genital warts can be passed on even if they are not visible. Most commonly, this is through sexual activity, such as vaginal, anal and oral sex, non-penetrative genital-to-genital contact, and sharing sex toys.   HPV is not passed on by casual contact such as kissing or hugging.  Symptoms  Genital warts are normally painless but, in some people, they can be itchy and become inflamed, which may cause a little bleeding. They can either appear on their own or in clusters. The most common places for them to appear are:  Around the opening of the vagina (vulva)  Around the cervix (the neck of the womb)  Inside the vagina  Around or inside the anus  On the upper thighs  Anywhere on the penis  On the scrotum  Inside the urethra (where urine comes out) in people with a penis   Testing If you suspect you or a sexual partner have genital warts, see your healthcare provider for a medical examination. Testing is usually not required for genital warts, but it is easy for a healthcare provider to diagnose by examining the area. In some cases, they may need to perform a more detailed examination in order to see if there are warts inside the vagina or anus.  Treatment    If you have visible genital warts, the two main types of treatment are:  applying cream or lotion to the warts  destroying the tissue of the warts by freezing, heating or removing them  Unfortunately, wart creams that are available over the counter will not be effective as because they are designed to only treat warts on the hands or verrucas.   The type of treatment you are offered depends on the warts. You should tell the healthcare provider if you are pregnant or if there is a risk of pregnancy as this may affect the type of treatment they are offered.  For some people it can take months for the treatment to work and for the warts to disappear.  It is recommended that you avoid having sex until your genital warts have fully healed. Not only will this help to ensure you don’t pass it on to others, but it may also help you recover more quickly.  Over time, genital warts will go away without treatment but if left untreated, they may also grow larger or multiply. They are rarely harmful to your health, but genital warts can be unpleasant and may cause discomfort.  Prevention   When used correctly and consistently, condoms can help protect you from HPV but may still be passed on by the surrounding genital areas coming into contact with the virus.  The HPV vaccine can protect against genital warts and types of HPV that can cause cancer, so it is worth checking if you are eligible to receive this.  Learn more about different types of STIs and their symptoms, treatment, and prevention