According to the World Health Organization, reproductive and sexual ill health accounts for 20% of the global burden of ill health for women, and 14% for men. These rates are often highest in marginalised populations with limited access to health services, increased exposure to infection, general poor health, and the effectives of living in poverty.
Although proven solutions for improving Sexual and Reproductive Health (SRH) exist, their implementation has been fragmented, with limited population impact, and little access for populations most at risk, such as sex workers. Integration of SRH services is key to achieving universal access to reproductive health. However, with weakened health systems and an HIV pandemic, the way forward is uncertain. The essential package of services and models for delivering them at high coverage in resource-limited settings are unclear.
The Diagonal Interventions to Fast Forward Enhanced Reproductive health (DIFFER) project was a “diagonal” strategy, incorporating both “horizontal” health systems strengthening and more targeted “vertical” approaches. Horizontal programmes can reach large numbers of women, while vertical programmes target high-risk populations, difficult to reach through a horizontal approach. The aim was improved SRH services through identifying best practices in delivering a combined package of interventions for general population women and female sex workers.
CHP and MatCH (Maternal, Adolescent and Child Health Division) provided formative information on SRH policy, especially of services for high-risk populations, by conducting a policy analysis of existing SRH services and undertake a situational analysis of existing SRH services. In addition, the Wits group was responsible for taking research to policy through activities and workshops involving local and national health authorities to develop, implement and evaluate a strategy to bridge the gap between research and health policy and service delivery guidelines.
This research involved both north-south and south-south collaboration, and for the first time brought the rich experience and successes of innovative, scaled-up sex worker-led interventions from the DMSC Sonagachi, Ashodaya and Avahan projects for adaptation to the African setting. The partners were the International Centre for Reproductive Health, University Ghent, Belgium; Ashodaya Samithi, India; International Centre for Reproductive Health, Kenya and Mozambique; the Centre for Health Policy and MatCH at the University of the Witwatersrand, South Africa; the Centre for International Health and Development, University College London, United Kingdom.
This challenging project offered significant capacity building opportunities to CHP staff, particularly in the adaptation of sex-worker interventions for the African context which have been so successful in India.
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W Delva, M Richter, P De Koker, M Chersich, M Temmerman. Sex Work during the 2010 FIFA World Cup: Results from a Three-Wave Cross-sectional Survey.PLoS ONE 2011 (in press)
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Veldhuijzen NJ, Ingabire C, Luchters S, Bosire W, Braunstein S, Chersich M, van de Wijgert, J Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV. Sex Health. 2011 Jun; 8(2):251-4.
Richter ML, Chersich MF, Scorgie F, Luchters S, Temmerman M, Steen R Sex work and the 2010 FIFA World Cup: time for public health imperatives to prevail.Global Health. 2010 Feb 11; 6(1):1
Luchters SM, Vanden Broeck D, Chersich MF, Nel A, Delva W, Mandaliya K, Depuydt CE, Claeys P, Bogers JP, Temmerman M Association of HIV infection with distribution and viral load of HPV types in Kenya: a survey with 820 female sex workers. BMC Infect Dis. 2010 Jan 26;10:18.