Primary Health Care and HIV: Convergent Action – Policy Considerations for Decision Makers – World

executive summary

The 2030 health-related Sustainable Development Goals call on countries to end AIDS as a public health threat and to achieve universal health coverage. The World Health Organization (WHO) promotes primary health care (PHC) as the primary mechanism for achieving universal health coverage, and a PHC approach is essential to ending AIDS and achieving other Sustainable Development Goals.

The PHC approach is defined as a whole-of-society approach to health, aimed at maximizing the level and distribution of health and well-being through three elements: (1) primary care and essential public health functions as the core of integrated health services; (2) multi-sectoral policies and actions; (3) empower people and communities;

This publication helps decision makers explore and optimize synergies between existing and future assets and investments aimed at both PHC and disease-specific responses, including HIV. Specifically, it aims to:

Provide guidance to policy makers, health system managers and program leaders from both PHC and HIV backgrounds on opportunities to strengthen PHC and collectively advance their efforts to eliminate AIDS as a public health threat.and

• Provide resources to all stakeholders who wish to contribute to strengthening PHC and synergistically eliminating AIDS as a public health threat. This includes people living with HIV, members of key vulnerable populations, community and civil society representatives, people working in all areas of the health system, researchers, funders and private sector decision makers.

In 2019, at the request of the World Health Assembly, WHO developed a PHC operational framework. This framework is based on a theory of change that describes how the core elements of the PHC approach translate into outcomes through 14 interrelated levers for action and investment.

• Political engagement and leadership.

• Governance and policy frameworks.

• Funding and resource allocation.

• Community and other stakeholder involvement.

• Models of care.

• Primary health care workers.

• Physical infrastructure.

• Pharmaceuticals and other health products.

• Working with private sector providers.

• Purchasing and payment system.

• Digital technology for health.

• Systems for improving quality of care.

• Primary health care oriented research.and

• Monitoring and evaluation

The PHC lever serves as a useful framework for jointly enhancing PHC and identifying opportunities to achieve HIV-specific goals. This same framework can be applied or adapted to other disease-specific responses, such as viral hepatitis, sexually transmitted diseases, tuberculosis, and non-communicable diseases.

Actions associated with each instrument are presented in this publication with the aim of providing illustrative examples of how PHC and HIV goals can be jointly advanced. PHC and HIV stakeholders should jointly decide which instruments should be prioritized in specific national and local contexts and define his PHC and HIV actions, coordinated or synergistic, to be carried out in relation to these instruments. Throughout this process, meaningful engagement between people living with and affected by HIV and the broader community, especially PHC, is essential.

National and local multisectoral and multistakeholder advisory groups or consultations addressing PHC and HIV can help inform and coordinate policy dialogue.

Such an approach would accelerate efforts to strengthen PHC while also helping to overcome obstacles to eradicating AIDS as a public health threat. Despite the existence of effective prevention, testing and treatment measures, HIV remains a major disease burden worldwide. Progress towards goals related to eradicating AIDS has generally slowed in recent years, and even reversed in some countries. In 2021, 1.5 million people will be infected with HIV and 650,000 will die from HIV-related causes. Five major populations (men who have sex with men, people who inject drugs, sex workers, transgender and gender-diverse people, and people in prisons and other closed settings) are disproportionately affected by HIV compared to the general population worldwide. Major populations and their sexual partners will account for 70% of new HIV infections in 2021, and limited data are available, suggesting that major populations are lagging behind in HIV testing and access to antiretroviral therapy.

People living with HIV and members of major groups experience high levels of stigma and discrimination, including in medical settings. Countering stigma and discrimination is an essential aspect of addressing their physical and mental health needs.

In the context of the HIV epidemic, a vulnerable population is a group of people who are vulnerable to HIV infection in a particular situation or setting. Vulnerable people therefore differ from country to country and region to region. Women, including pregnant and lactating women, adolescent girls, and young people, including children, adolescents and key populations, are vulnerable to HIV infection in certain settings. Men and boys are less likely to access health services and, in some circumstances, worse off. Other vulnerable groups may include persons in situations of humanitarian concern, such as persons with disabilities, indigenous peoples, migrants, migrants, and those affected by conflict or civil strife.

Achieving many of the Sustainable Development Goals, including eradicating AIDS as a public health threat, and sustaining these achievements in the face of the complex demands placed on health and development systems will require new ways to use health system resources. Scaling up quality, human-centred services through a PHC approach is critical to achieving both disease-specific and broader health goals. The PHC approach promotes the overall health and well-being of people living with or at risk of HIV, including members of key vulnerable populations. In addition, HIV resources and lessons can be applied to many aspects of reorienting the healthcare system towards her PHC. All citizens should be able to access health services and benefit from health system resources without prejudice or discrimination.