Attachments
Executive summary
The 2030 health-related Sustainable Development Goals call on countries to end AIDS as a public health threat and also to achieve universal health coverage. The World Health Organization (WHO) promotes primary health care (PHC) as the key mechanism for achieving universal health coverage, and the PHC approach is also essential for ending AIDS and reaching other Sustainable Development Goal targets.
The PHC approach is defined as a whole-of-society approach to health that aims to maximize the level and distribution of health and well-being through three components: (1) primary care and essential public health functions as the core of integrated health services; (2) multisectoral policy and action; and (3) empowered people and communities.
This publication helps decision-makers to consider and optimize the synergies between existing and future assets and investments intended for both PHC and disease-specific responses, including HIV. Specifically, it aims to:
• provide guidance to policy-makers, health system managers and programmatic leads from both PHC and HIV backgrounds regarding opportunities to jointly advance their respective efforts to strengthen PHC and end AIDS as a public health threat; and
• provide a resource for all stakeholders who seek to contribute to strengthening PHC and ending AIDS as a public health threat in a synergistic manner, including people living with HIV, members of key and vulnerable populations, community and civil society representatives, people working in all areas of health systems, researchers, funders and private-sector decision-makers.
In 2019, at the request of the World Health Assembly, WHO developed a PHC operational framework. The framework is based on a theory of change that describes how the core elements of the PHC approach can be translated into results through 14 interrelated levers for action and investment:
• political commitment and leadership;
• governance and policy frameworks;
• funding and allocation of resources;
• engagement of community and other stakeholders;
• models of care;
• primary health care workforce;
• physical infrastructure;
• medicines and other health products;
• engagement with private-sector providers;
• purchasing and payment systems;
• digital technologies for health;
• systems for improving the quality of care;
• primary health care-oriented research; and
• monitoring and evaluation
The PHC levers serve as a useful framework for identifying opportunities to jointly strengthen PHC and meet HIV-specific goals. This same framework can be applied to or adapted to other disease-specific responses such as those addressing viral hepatitis, sexually transmitted infections, tuberculosis and noncommunicable diseases.
Actions are presented in this publication in relation to each lever with the intention of offering illustrative examples of how PHC and HIV goals can be jointly advanced. PHC and HIV stakeholders should work together to decide which levers should be given priority in their specific national and subnational settings and should define the collaborative or synergistic PHC and HIV actions that will be carried out in association with these levers. Throughout this process, the meaningful engagement of people living with and affected by HIV alongside the broader PHC-focused communities is essential.
National and subnational multisectoral and multistakeholder advisory groups or consultations addressing PHC and HIV may help to inform and to coordinate policy dialogue.
Such an approach can accelerate efforts to strengthen PHC while also helping to overcome obstacles to ending AIDS as a public health threat. Despite the existence of effective prevention, testing and treatment tools, HIV continues to impose a heavy burden of disease worldwide. Progress toward targets associated with ending AIDS has slowed overall in recent years and has even been reversed in some countries. In 2021, 1.5 million people acquired HIV and 650 000 people died from HIV-related causes. Five key 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 with the general population in all parts of the world. Key populations and their sexual partners accounted for 70% of new HIV infections in 2021, and the limited available data suggest that key populations lag behind in undergoing HIV testing and utilizing antiretroviral therapy.
People living with HIV and members of key populations experience high levels of stigma and discrimination, including in health care settings. Countering stigma and discrimination is an essential aspect of addressing their physical and mental health needs.
In the context of the HIV epidemic, vulnerable populations are groups of people who are vulnerable to HIV infection in certain situations or contexts. Vulnerable populations thus vary across national and subnational settings. Women, including pregnant and breastfeeding women and adolescent girls, as well as children, adolescents and young people, including young key populations, are vulnerable to HIV infection in specific contexts. Men and boys are less likely to use health services and have poorer health outcomes in some settings. Other vulnerable populations may include people with disabilities, indigenous peoples, migrants and mobile populations and people in settings of humanitarian concern, including people affected by conflict and civil unrest.
Achieving many of the Sustainable Development Goals, including ending AIDS as a public health threat, and sustaining these gains in the face of the complex demands being placed on health and development systems, will require using health system resources in new ways. Scaling up high-quality people-centred services through a PHC approach is critical for achieving both disease-specific and broader health aims. The PHC approach promotes the overall health and well-being of people who are living with or at risk of HIV, including members of key and vulnerable populations. Further, HIV resources and lessons can be channelled into many aspects of reorienting health systems towards PHC. Members of all populations must be able to access health services and benefit from health system resources free from stigma and discrimination.