Sexual and reproductive health in HIV-related proposals supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria

Objective To assess the sexual and reproductive health interventions included by countries in HIV-related proposals approved by theGlobal Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).Methods We examined the Global Fund database for elements and indicators of sexual and reproductive health in all approved HIVrelatedproposals (214) submitted by 134 countries, from rounds 1 to 7, and in an illustrative sample of 35 grant agreements.Findings At least 70% of the HIV-related proposals included one or more of the four broad elements: sexual and reproductive healthinformation, education and communication; condom promotion/distribution; diagnosis and treatment of sexually transmitted infections;and prevention of mother-to-child transmission of HIV. Between 20% and 30% included sexual health counselling, gender-based violence,and the linking of voluntary counselling and testing for HIV with sexual and reproductive health services. Less than 20% focused onadolescent sexual and reproductive health, the rights and needs of people living with HIV, or safe abortion services. All these elementswere rarely featured, if at all, in the grant agreements reviewed. Overall, however, sexual and reproductive health indicators did appearin most HIV-related proposals and in more than 80% of the grant agreements.Conclusion Country coordinating mechanisms and national-level stakeholders see in funding for sexual and reproductive health ameans to address the problem of HIV infection in their respective national settings. However, we highlight some missed opportunitiesfor linking HIV and sexual and reproductive health services.