Evaluate how the two initiatives contribute to the provision of an enabling environment for children
Creating an enabling environment for the SRHR of women living with HIV should embrace the following strategies: Take a holistic approach: Making the environment more enabling requires working at multiple levels across the social ecological framework see section 3.
HIV treatment can increase the need for food security, as women living with HIV may not only need food for nourishment and the maintenance of health, but also to support ART initiation and adherence, and to manage ART side-effects.
In areas with high levels of poverty and food insecurity, the same linkages to services through health-care facilities may need to be made for all individuals to avoid tensions between people living with HIV and those who are not but who also need food, and to avoid incentivizing HIV acquisition.
The health system may need to pay special attention to helping HIV service providers implement these recommendations, given their general focus on treatment adherence and transmission prevention.
Components of an enabling environment Efforts to address violence against women living with HIV must involve other sectors along with the health sector.
What does it mean to provide an enabling environment?
Information gaps should be identified and filled through appropriate research, including community-driven research. Information should be reliable and accurate and it needs to be trusted by patients, who rely on it to support their informed decision-making about their personal health and well-being and about their interactions with health systems. Poverty emerged as a major concern for women growing older with HIV, especially for women who do not have children, are widowed or without a partner, or who have no access to insurance or pensions. Invest in long-term programming: Examples of this approach include creating SRH and HIV programme plans with a 10—15 year horizon, investing in capacity-building, and working to change destructive social norms, instead of short-term crisis-response activities. This is central to creating an environment that promotes SRHR With regard to the role of law and policy reforms to better protect the rights and safety of all women, including women living with HIV in all their diversity, this can include: advocacy to increase awareness of reporting mechanisms and disciplinary action; conducting sensitization workshops for people with pivotal roles in the community e. Comprehensive, rights-based family planning FP services are a core component of an integrated SRH and HIV services package, which enables women with HIV to pursue their fertility goals, including planning for safer pregnancies, spacing desired pregnancies and preventing unintended pregnancies. These barriers need to be taken into account when putting in place strategies for improving the accessibility, acceptability, uptake, equitable coverage, quality, effectiveness and efficiency of services for women living with HIV. It is important to ensure that providers have appropriate training as outlined in the guideline, as their work relates to special considerations for women living with HIV. They will need support for ongoing healthy sexuality and sexual health decision-making. There is international consensus around the need for effective linkages between responses to HIV and SRH, including recommendations for specific actions at the levels of policy, systems and services
While the health sector is central to the scope of this guideline, successful implementation of actions for a safe and supportive environment for women living with HIV requires collaboration across multiple sectors, such as justice, housing, agriculture, education, welfare and labour.
Components of an enabling environment SRH services should support healthy sexuality across the life course, including offering accessible and acceptable services to all women living with HIV, including older women. Provision of information regarding sustainable food practices can be a useful and relatively low-cost intervention.
Introducing key changes to the communication environment could sometimes immediately and significantly promote greater spontaneous communication.
Certain core values should accompany interventions to create safety for women living with HIV and thereby foster improved SRH and realization of their rights.
How to work with others to create enabling play environment
Women living with HIV in many societies around the world continue to face multiple and intersecting forms of discrimination and are denied their basic human rights, especially in relation to health care. This may increase negative SRH outcomes, including unplanned, undesired or inadequately spaced pregnancies, untreated STIs, and others. While some laws serve to protect young people, national age of consent laws and social norms can also influence service providers' attitudes and behaviours and create barriers to service access. Women living with HIV stated that compassionate, holistic, unconditional care and support and informed choice should be provided to all women living with HIV in the context of services related to pregnancy and fertility desires, and the enjoyment of healthy sexuality. Jo We observed Jo, a five-year-old child with severe autism and no speech, for a full school day. Box 3. Moralistic attitudes or values and lack of the required competencies often stand in the way of health workers providing adolescents living with HIV with the health services they need.
Women living with HIV must be supported in their voluntary choices around sexual relationships and be given information and resources to engage in safe, enjoyable sexual experiences, or to not engage in sex, depending on their personal preference, with counselling and support tailored to their decision-making, desires and needs.
The training should cover what women are told when they are diagnosed with HIV in relation to their sexuality across the life course, and for their specific life course stage.
Because of their common experiences, peers can also help adolescents living with HIV to cope with fear, hopelessness, stigma and discrimination, and they can facilitate problem solving.
based on 107 review