The Basket Indicator – Strengthen HIV integration

The primary strength of this indicator is its ability to collect a significant amount of data on HIV and SRH service delivery using a simple and straightforward questionnaire. The reported data can be used in multiple ways to assess integration between SRH and HIV services at the level of the service delivery point.

Given the currently low level of integration between HIV and SRH services, this indicator may provide limited information on the breadth and depth of linkages. However, over the long term, as integration between HIV and SRH services become more common, the indicator will be increasingly useful for assessing linkages generally and integration between individual services more specifically.

One potential weakness of the indicator is the inclusion of STI screening, diagnosis and treatment as an HIV service as well as an SRH service. The delivery of STI services can and should vary based on the context and the population. For example, STI services available at a delivery point may not be sensitive to the specific circumstances facing people living with HIV. Similarly, not all delivery points providing STI services are capable of dealing with key populations, such as female sex workers or men who have sex with men. As a result, the reported data may show integration in STI services that are not necessarily practical, desirable and/or effective.

There is a parallel concern about condom provision, which also appears under HIV and SRH services. Including condom provision under both types of services flags the overlapping use of condoms for disease and pregnancy prevention. In general, service delivery points focused on HIV-related services distribute condoms to prevent the spread of HIV, not to prevent pregnancy. To simply count condom distribution by service delivery points as an SRH service could provide misleading data on the integration between HIV and SRH services.