Community Innovation: Achieving Sexual and Reproductive Health and Rights for Women and Girls Through the HIV Response

This 44-page report shares case studies gathered by the ATHENA Network and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to identify key examples of community innovation to achieve sexual and reproductive health and rights through the HIV response, and vice-versa, for women. The case studies from across sub-Saharan Africa, South Asia, Europe and Central Asia, Latin America, and North America, are intended to highlight the rich diversity of community initiatives that bridge sexual and reproductive health and rights and HIV. According to the publication, the main lesson to draw from this broad range of strategies is the importance of community engagement and the key leadership role that women living with HIV have to play in tailoring the HIV response to their needs.

The report places strategic emphasis on innovation led by women living with HIV and features endeavours that reflect community and key stakeholder interpretation and understanding of how this intersection is defined. The strategies demonstrate a broad spectrum of the overlap between sexual and reproductive health and rights and HIV. Creating an enabling environment for women in all their diversity – especially for women living with HIV – to access services and fulfil their human rights, is one of the central tenets of the UNAIDS Agenda for Women and Girls. Equally important is the support for leadership and meaningful participation by networks of women living with HIV, and other women's groups, in addressing gaps in services and barriers to achieving women's rights to sexual and reproductive health.

The case studies are organised into the following sections.

• Breaking the silence on taboo issues.
• Coalition building across intersecting movements.
• Prioritising women on the margins: bringing the margins to the centre.
• Addressing gender-based violence as a cause and consequence of HIV.
• Championing positive motherhood: peer to peer mentorship by women living with HIV.
• Advancing reproductive justice for women of colour.
• Engaging young people through comprehensive sexuality education.

The report shares case studies such as the following.

• In Malawi, Marie Khudzani Banda, together with the International Community of Women Living with HIV/AIDS (ICW) and with support of Ipas, mobilised ICW members around sexual and reproductive health and rights – particularly focusing on reproductive choice. ICW members then carried out a series of community meetings with HIV-positive women focusing on the topics of contraception, early pregnancy, unwanted pregnancies, and unsafe and safe abortion, with the aim of breaking the taboo and reducing stigma associated with abortion.
• Sonke’s Khayelitsha Termination of Pregnancy Community Project, which ran from January 2009 to March 2010, worked to educate and involve men in matters pertaining to their and their partners’ sexual and reproductive health and rights, and to create safe and stigma-free access to abortions in the community. The project inspired a broader campaign across South Africa to engage men and boys in halting domestic and sexual violence and to prevent the spread of HIV. The Khayelitsha project trained twelve peer outreach workers using Sonke’s One Man Can programme tools, and provided them with mentoring to identify and reach large numbers of men in the community. Men were reached through soccer clubs, drinking establishments, clinics, community-based organisations, parks and even in their homes.
• Mama’s Club, a community-based organisation led by women living with HIV in Uganda, brings women together in response to the sense of isolation and concern experienced by newly diagnosed HIV-positive women facing pregnancy, through peer mentorship and support. Mama's Club was envisioned as a community-based model of expanding prevention of vertical transmission services to a family-centred approach to meet the needs of the mothers, engage fathers, and ensure the wellbeing of all the children in the family.

The report notes that when HIV and sexual and reproductive health and rights providers come together to empower affected communities to take the lead, enabling environments are created that help to open discussion, improve knowledge of the issues affecting women living with HIV, and ultimately improve access to comprehensive and holistic services that advance women’s and girls’ health and rights. Effective initiatives include training members of the community as advocates, providing safe arenas for open discussion and engaging men as codrivers of social change.

In conclusion, learning from these community case studies is an opportunity to enhance the AIDS response, in light of the Millennium Development Goals and the 2011 Political Declaration on HIV/AIDS. The case studies indicate that for responses to be effective they must include the empowerment and inclusion of women in all their diversity, dedicate attention to sexual and reproductive health, including improvements in maternal and child health, and address the socio-cultural practices underlying gender inequality.