WHO Releases Women-Centered HIV Guideline

Recently, the World Health Organization (WHO) submitted a new guideline on sexual and reproductive health and the rights of women who are living with HIV. The guideline stresses the importance of taking a women-centered approach to healthcare services, an approach that is guided by two important principles: human rights and gender equality.

On International Women’s Day, a global holiday dedicated to not only celebrating the achievements of women around the world but stressing the need for gender equality, Contagion^® takes a closer look at a guideline that illustrates that an “integrated approach to health and human rights lies at the heart of ensuring the dignity and well-being of women living with HIV.”

WHO reports that in 2015, 17.8 million women aged 15 years and older were estimated to be living with HIV. Notably, adolescent girls and young women between the ages of 15 and 24 are a population that is particularly affected by the virus. In fact, this population accounts for 60% of young individuals within that age group living with HIV as well as 58% of new HIV cases.

“In many countries, women living with HIV do not have equitable access to good-quality health services and are also faced with multiple and intersecting forms of stigma and discrimination,” according to WHO; they are also “disproportionately vulnerable to violence, including violations of their sexual and reproductive rights.”

With these new guidelines, WHO expects that healthcare providers, public health policy makers, and program managers can “better address the sexual and reproductive health and rights (SRHR) of women living with HIV,” since the guideline addresses “key issues for providing comprehensive SRHR-related services and support for women living with HIV.”

WHO points out that HIV-infected women face many “unique challenges and human rights violations” when it comes to sexuality and reproduction, in their familial sphere, in the community, and even at healthcare institutions where they seek medical care. In order to address this, the guideline calls for the creation of healthcare settings that would not only allow for more efficient intervention, but would also facilitate overall superior healthcare results.

On a global scale, the guideline is meant to assist countries in the planning, development, and monitoring of programs and services “that promote gender equality and human rights” that are “more appropriate” for HIV-infected women. In addition, the guideline touches on issues related to the implementation of these programs and services that officials will need to address in order for the services to be successful.

The guideline also stresses the importance of taking a woman-centered approach to health services, which means that women are not only “active participants,” but they are also “beneficiaries” of health systems that “respond to women’s needs, rights, and preferences in humane and holistic ways.” In addition, care must be provided by health systems that respects “women’s autonomy in decision-making” and provides them with information/options that will allow them to make informed decisions regarding their healthcare.

According to the WHO guideline, a woman-centered approach is supported by two guiding principles:

1. Human rights: “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.”
2. Gender equality: the importance of “recognizing 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.”

An essential focus of the guideline is to provide:

• Evidence-based recommendations for the SRHR of women living with HIV in all of their diversity, with a particular focus on settings where the health system has limited capacity and resources; and
• Good practice statements on key operational and service delivery issues that need to be addressed to: (i) increase access to, uptake of, and the quality of outcomes of sexual reproductive health (SRH) services; (ii) improve human rights; and (iii) promote gender equality for women living with HIV.

In order to make sure that the guideline would accurately incorporate the concerns of HIV-positive women, WHO conducted a Global Values and Preferences Survey, and later incorporated the survey’s results within the guideline. To define the scope of the guideline, all WHO SRHR guidance for HIV-positive women were reviewed to see if past recommendations were relevant, or if needed to be updated. They determined eight areas that can be used for new recommendations/good practice statements:

1. Psychosocial support
2. Ageing and healthy sexuality
3. Economic empowerment and resource access (including food security)
4. Integration of SRHR and HIV services
5. Empowerment and self-efficacy around safer sex and reproductive decision-making
6. Facilitating safe disclosure for women living with HIV who fear or experience violence
7. Modes of delivery for best maternal and perinatal outcomes (specifically caesarean section)
8. Safe medical and surgical abortion

Some of the recommendations dedicated to creating an enabling environment called for “healthy sexuality across the life course, integration of SRHR and HIV services, protection from violence and creating safety, [and] community empowerment.” Recommendations pertaining to health interventions included “sexual health counseling and support, violence against women services, family planning and infertility services, antenatal care and maternal health services, safe abortion services, [and] sexually transmitted infection and cervical cancer services.” View the guideline to see the full list of recommendations.

WHO also included a number of good practice statements dedicated to the advancement of SPHR of HIV-positive women, which is illustrated in the image below:

Taking a women-centered approach to healthcare regarding HIV is important, especially since young women and adolescents between the ages of 15 and 24 account for such a large percentage of those living with the virus. In response to these troubling numbers, WHO created a guideline that has been developed with the needs of women in mind with the hopes that if some of these recommendations are implemented, HIV-positive women around the world will have a safe environment that respects their rights and wellbeing.