ADDIS ABABA, Ethiopia -- A young Ethiopian woman went to a health clinic and found out she was pregnant. She was asked to take an HIV test and found out she was HIV positive. She told her husband she was pregnant but not about being HIV positive, and she suggested they be tested together. He refused, and said he would leave her if she got tested. She decided to have an abortion and went to a health professional who advised her against it. At that point, she decided to have her baby despite the fact that she had no support from her husband.
Universal health coverage should be seen as a key mechanism for achieving the health goal if it also addresses the economic and social determinants of health, including equity and the right to health.That story was acted out in a session at the International Conference on Family Planning held here from November 12-15, but is based on a true story. It is one of many such storylines being played out in real life by the five million young people aged 15-24 living with HIV, especially by young women living with HIV, young sex workers, young men who have sex with men, young transgender people and young people who use drugs. This is true because they are the people least able to access sexual and reproductive health services, including family planning. They also face stigma and discrimination based on age, gender, HIV status and sexual orientation.
The purpose of the session was to promote greater commitment to the integration of HIV and sexual and reproductive health and rights (SRHR) in the context of ongoing negotiations on the development agenda after 2015, when the current Millennium Development Goals expire. Specifically, it promoted greater attention to the need to integrate SRHR and HIV prevention and treatment among these vulnerable young people and the meaningful involvement and greater voice of young people living with and affected by HIV in the post-2015 agenda.
Members of a youth group in Addis Ababa meet regularly to debate sexual and reproductive health issues. Photo © Sheikh Rajibul Islam
"Delegates who come to the African Union and the United Nations must speak your voice," Dr. Ademola Olajide, head of Health, Population and Nutrition of the African Union Commission, told the largely young audience. "The most important thing is that you advocate in your countries so when your delegates go to Addis Ababa and New York, they speak your voice. The window is closing for making SRHR a human right."
Lambert Grijns, the Dutch ambassador for SRHR and HIV/AIDS at the Ministry of Foreign Affairs, also urged participants to fight to get SRHR on the post-2015 agenda: "We've seen increases in funding for HIV treatment and we can all be proud of that. But we haven't seen equivalent increases for HIV prevention. Donors sometimes neglect prevention because it is sensitive and harder to implement. Some people engage in risky behavior because they know treatment is there. SRHR should not be seen in isolation but should be linked to other areas. And we have to have targets, such as [those in place for preventing] child marriage."
Dr. Pride Chigwedere, senior advisor to the African Union, UNAIDS, exhorted young people to fight to get their voices heard. "Young people have to take their stand and state what their priorities are for post-2015."
The International HIV/AIDS Alliance, which has just published a discussion paper on "Health in the Post-2015 Sustainable Development Framework" says the overarching health goal in the post-2015 agenda should be "outcome-focused, formulated along the lines of ensuring healthy lives at all ages. Universal health coverage should be seen as a key mechanism for achieving the health goal if it also addresses the economic and social determinants of health, including equity and the right to health.
By "outcome-oriented," the Alliance means that each component of universal health coverage should be as concrete and measurable as possible with four distinct but linked targets:
- An access target framed around ensuring universal access to health care
- A target related to financial risk protection, which ensures the affordability of services so that all people can receive the quality health services they need without suffering financial hardship
- A target related to ending preventable morbidity and mortality by reducing child, infant and neonatal mortality, maternal mortality, non-communicable disease, neglected tropical disease, AIDS malaria and tuberculosis
- A target related to enabling healthy behavior and tracking "subjective well-being"
The conference session was organized by the consortium partners of the new Link Up program, which aims to advance the SRHR of more than one million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. It is led by the Alliance and implemented by the Alliance, Marie Stopes International, STOP AIDS NOW! and others, and funded by the Dutch Ministry of Foreign Affairs.