The international community agrees that the Millennium Development
Goals will not be achieved without ensuring universal access to both
sexual and reproductive health (SRH) services and HIV/AIDS prevention,
treatment, care and support. Recently, there has been increasing
awareness and discussion of the possible benefits of linkages between
SRH and HIV programmes at the policy, systems and service delivery
levels. However, the evidence for the efficacy of these linkages has not
been systematically assessed.
We conducted a systematic review of the evidence for interventions
linking SRH and HIV. Structured methods were employed for searching,
screening and data extraction. Studies from 1990 to 2007 reporting
pre-post or multi-arm evaluation data from SRH-HIV linkage interventions
were included. Study design rigour was scored on a nine-point scale.
Unpublished programme reports were gathered as \"promising practices\".
Of more than 50,000 citations identified, 185 studies were included in
the review and 35 were analyzed. These studies had heterogeneous
interventions, populations, objectives, study designs, rigour and
measured outcomes. SRH-HIV linkage interventions were generally
considered beneficial and feasible. The majority of studies showed
improvements in all outcomes measured. While there were some mixed
results, there were very few negative findings. Generally, positive
effects were shown for key outcomes, including HIV incidence, sexually
transmitted infection incidence, condom use, contraceptive use, uptake
of HIV testing and quality of services. Promising practices (n = 23)
tended to evaluate more recent and more comprehensive programmes.
Factors promoting effective linkages included stakeholder involvement,
capacity building, positive staff attitudes, non-stigmatizing services,
and engagement of key populations.
Existing evidence provides support for linkages, although significant
gaps in the literature remain. Policy makers, programme managers and
researchers should continue to advocate for, support, implement and
rigorously evaluate SRH and HIV linkages at the policy, systems and
Kennedy, C.; Spaulding, A.; Brickley, D.B.; Almers, L.; Mirjahangir, J.; Packel, L.; Kennedy, G.; Mbizvo, M.; Collins, L.; Osborne, K. Linking sexual and reproductive health and HIV interventions: a systematic review. Journal of the International AIDS Society (2009) 13 (1) 26. [DOI: 10.1186/1758-2652-13-26]
Linking sexual and reproductive health and HIV interventions: A systematic review and meta-analysis.