Last week at the 69th World Health Assembly (WHA), the Global Health Sector Strategies for HIV, viral hepatitis and sexually transmitted infections (STIs), 2016-2021 were formally adopted on 28 May.
This is an important milestone as the three strategies are fully aligned with supporting the attainment of the Sustainable Development Goals (SDGs), which include targets to end the HIV epidemic as a public health threat by 2030 and to combat viral hepatitis and other communicable diseases, including STIs. The successful adoption of the three Global Health Sector Strategies for HIV, viral hepatitis and STIs provides an avenue for focused priority setting across the health response. These targets represent the following key benchmarks:
Greater integration across three disease areas
The Global Health Sector Strategies aim to prevent the negative health and economic impacts of global HIV, hepatitis and STI epidemics, and help focus investments on high-impact disease-specific interventions and services. The first-ever global hepatitis targets towards elimination of viral hepatitis by 2030 were adopted. The links between HIV and co-infection with hepatitis is an area that requires additional resources and commitment. This is especially critical to ensure that pricing of curative medication is within the reach of countries where co-infection, especially with hepatitis C (HCV), is a driver of both epidemics. Interventions identified for prioritized scale-up in the Global Health Sector Strategies include hepatitis B (HBV) vaccination - childhood vaccine coverage; prevention of mother-to-child transmission of HBV - including birth-dose vaccine coverage; safe injection, blood and medical procedures; harm reduction for injecting drug users; HBV treatment (lifelong treatment); and HCV treatment (cure). The links between HIV and STIs have long been recognized and acting on these linkages, especially for men and boys, provides a platform to engage men as recipients of sexual health services. The Interagency Working Group on Sexual and Reproductive Health and Rights (SRHR) and HIV, chaired by the World Health Organization (WHO) and United Nations Population Fund (UNFPA), provides a useful platform to ensure that the synergies are acted upon. ‘People-centered’ approaches towards all three disease areas will ensure greater uptake and accessibility, and it is imperative that the approach constantly ensures that they promote and encourage health seeking behaviors.
Greater synergy from partners across the health sector
Across the world, the health care work force is key for the successful implementation of these strategies. It is imperative that programmes are both strengthened and taken to scale to ensure that health care workers have the tools at their disposal to ensure quality service delivery. Stigma and discrimination are frequently highlighted as a critical issue to address for all three disease areas. By working in partnership with the communities they serve, health care providers should be given opportunities to proactively address stigma and discrimination within health care settings. Pre and in-service training that addresses issues of stigma and discrimination will ensure that frontline health care workers are equipped to respond to the needs of their clients. Since these strategies will now both guide regional and national strategies, and the actions of the WHO and partners and also ensure policy and programme coherence, it will be important to facilitate stronger linkages and innovative partnerships.
Greater focus on primary health care service delivery
Health system strengthening, notably primary health care, was a notable feature of many of the interventions made by Member States. While the importance of addressing the nuances of each disease area was highlighted, the value of ensuring that strategic investments are made in strengthening health systems was emphasized. The important lessons of, in particular, the HIV response in strengthening and shaping health systems should be applied. Integration of service delivery approaches, including differentiated models across the cascade of prevention, care and treatment, will support optimization and efficiency.
The adoption of the Global Health Sector Strategies provides a platform that highlights a number of areas for joint advocacy to support their implementation. These include:
- Addressing drug pricing especially of vital hepatitis treatments
- Increasing financial investments to address these three diseases areas
- Increasing engagement of populations most affected by HIV, STIs and viral hepatitis, including a purposeful focus on key populations across all epidemic scenarios– men who have sex with men, people who inject drugs, transgender people and sex workers
Building upon this success, the upcoming United Nations High Level Meeting on HIV in June and the 21st International AIDS Conference (AIDS 2016) in July provide an opportunity to ensure further political commitment that is needed to end AIDS. It is an opportunity that, like the adoption of these proactive health sector strategies, must be seized if stigma is to be reduced, if lives are to be saved, and if no one is to be left behind.