Professor Helen Rees, OBE
When RHRU added "HIV" to its name and became the “Reproductive Health and HIV Research Unit” it was doing two things. The first was to ensure its name reflected more accurately the scope of the work it does. The second was to signal the inseparable relationship between research and policy on reproductive health and research and policy on HIV and AIDS. This relationship might not apply in all developed countries but is an inescapable fact to a research unit like ours, operating in a developing country with such high HIV prevalence rates.
The challenge is to get health care professionals who work in reproductive health and those who work in antiretroviral-rollout clinics to act on this common ground in the way they treat their patients. Health workers in fertility clinics do not always ask would-be mothers whether they have considered HIV testing. Similarly, health workers in antiretroviral clinics do not ask young women whether they intend becoming pregnant, even though this is their decision to make and despite the fact that certain therapies can be harmful to a foetus. HIV seems to have eclipsed the importance of sexual and reproductive health in the way we think. HIV patients have been reduced to one-dimensional characters incapable of having health-related needs other than those determined by their HIV status.
Johannesburg Hospital’s antenatal antiretroviral clinic is a good example of a service-delivery model where the two ideologies of sexual and reproductive health, on the one hand, and HIV and AIDS, on the other, have merged. This clinic is part of the routine antenatal services the hospital provides. RHRU helped establish this after the failure of attempts to ensure prompt treatment for pregnant women in the queues at the hospital’s adult antiretroviral clinic. We are keen to promote the replication of the model that the new clinic is based on, in other urban areas of South Africa and in rural areas.
RHRU also firmly supports female-initiated mechanisms for reducing HIV transmission, such as the female condom and microbicides. Although the female condom is currently expensive and, therefore, unlikely in its current state of development to be given much support by any government, microbicides are firmly on the HIV-prevention policy agenda. RHRU’s support for the microbicide gels currently under research is due to their efficacy in HIV infection and the response they present to the gendered nature of HIV infection. Microbicides, as a female-controlled mechanism, are a way for women who are unable to negotiate condom use to retain power in their sexual relationships, in the face of the widely held myth about women’s powerlessness in this area of their lives.
Unlike our work with microbicides, which has to date taken the form of collecting the evidence for policy on HIV prevention, much of RHRU’s work takes place at the other end of the continuum – providing training in clinical and counselling skills to the health professionals in clinics in all nine provinces, many of these in under-resourced areas. It is in this setting that we can directly measure the value we add to the government’s rollout plan and to the people in remote communities whose lives we touch.
Naturally, we are constantly seeking out, on the biomedical and social science fronts, where else and in what other ways we can add value. We consciously choose to apply our expertise and skills through strengthening existing service interventions and providing cross-cutting and ground-breaking approaches to existing structures. In this way we avoid duplication of services, actively encourage coordination of service delivery, and are much better placed to identify the most effective way to make a positive impact on health initiatives in South Africa. For this reason, RHRU has proactively gone into hostels, engaged with truckers and sex workers, asked men and women how we can change their lives around, and sought their opinions on the effectiveness of the messaging that HIV-prevention campaigns have used so far.
The 15% HIV prevalence rate among female adolescents and the results of an 11 000-strong survey of adolescents tell us that interventions on sexual behaviour, gender views, violence and fertility choices still need urgent attention in this vulnerable group. As our partnership with government grows and as we strengthen our uniqueness as a unit that covers both the scientific and the practical aspects of sexual, reproductive and HIV-related health, we’ll put the lessons we learn to good use for this group and others.