Integrating HIV and Sexual Health Care: Overcoming Global Barriers

The integration of HIV care and sexual health services is increasingly recognized as essential for improving health outcomes worldwide. However, experts at the International AIDS Society (IAS) 2025 conference, held in Kigali, Rwanda, highlighted significant challenges including global stigma, funding cuts—particularly the recent defunding of USAID—and structural barriers that impede progress in the field.

During a panel discussion titled ‘Time to bring HIV, sexual and reproductive health together for better care,’ experts underscored the overlapping nature of HIV and sexual health care, which presents a unique opportunity to address both issues simultaneously. According to Dr. Andrew Grulich, head of the HIV Epidemiology and Prevention Program at The Kirby Institute, the World Health Organization (WHO) emphasizes the importance of person-centered care and aims to end pandemics related to HIV and sexually transmitted infections (STIs). However, the stigma surrounding these topics complicates discussions and actions necessary for progress.

Dr. Grulich stated, “In many countries, politicians don’t want to talk about sex. When you have meetings at the UN where some countries find it discomforting even to talk about sexual matters, it’s a great impediment to progress in this field.”

Mitchell Warren, executive director of AVAC, identified the defunding of USAID in January 2025 as a critical setback for both HIV and contraceptive services. “Since January 20, an agency that has been the leader, not only in HIV but also in contraception and family planning, doesn’t exist any longer,” Warren said, pointing to the significant reduction in available resources. While the President's Emergency Plan for AIDS Relief (PEPFAR) continues to operate, its focus is limited, particularly regarding pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women.

The effects of USAID’s funding cuts are illustrated by the case of the Tangerine Clinic in Thailand, which has provided crucial health services to transgender individuals since its inception in 2015. Following the funding cuts, the clinic experienced a 20% decrease in clients due to the shift to a fee-for-service model. This shift has resulted in increased mental health issues among clients, with reports of depression and suicidality affecting at least 20% of them.

Felix Mugaka, MBChB, a research scientist at the Kenya Medical Research Institute, shared insights on innovative solutions in HIV prevention. He explained how a project in Kenya is providing HIV prevention alongside contraception and STI testing through retail pharmacies. These pharmacies serve as vital access points for approximately half of individuals in sub-Saharan Africa, who prefer them over government clinics due to shorter wait times and extended operating hours. Dr. Mugaka emphasized the importance of addressing the needs of women, particularly as 40% of women in Kenya seek contraception in environments where public healthcare settings may lack essential services.

Dr. Deborah Anderson, a professor at Boston University Chobanian & Avedisian School of Medicine, noted the alarming statistics surrounding unintended pregnancies, stating, “About half of all pregnancies are unintended in the world, and 95% of unintended pregnancies occur in women who do not use modern contraception or use it infrequently or improperly.”

Warren concluded the discussion by emphasizing the need for a paradigm shift in addressing these challenges. “We’ve just had a series of massive quakes, and we’ve got to now build differently,” he stated, urging stakeholders to adapt to the current landscape of global health funding and service delivery.

The IAS 2025 conference highlighted the urgent need for collaboration among governments, health organizations, and community leaders to integrate HIV and sexual health services effectively. As the world continues to grapple with these intertwined issues, the commitment to person-centered care and innovative solutions remains critical for improving health outcomes and reducing stigma.

With ongoing challenges, the future of HIV and sexual health integration depends on sustained advocacy, adequate funding, and the dismantling of barriers that prevent open discussions about sexual health—a crucial step toward ending the HIV epidemic and ensuring comprehensive healthcare for all.