The overlap of HIV care and sexual health care presents an opportunity to address both at the same time; however, funding challenges, stigma and research gaps prevent this from happening, according to a panel discussion called ‘Time to bring HIV, sexual and reproductive health together for better care,’ presented today at the International AIDS Society (IAS) 2025 meeting in Kigali, Rwanda.
Person-centered care and interest in ending pandemics as a public health threat are both listed as global goals from the WHO concerning HIV and sexually transmitted infections (STIs), according to Andrew Grulich, Ph.D., head of the HIV Epidemiology and Prevention Program at The Kirby Institute. These issues also both carry stigma, which makes them difficult subjects to address.
“In many countries, politicians don’t want to talk about sex,” Grulich said. “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, cited the January 2025 defunding of USAID as a major challenge for funding and care. For example, while PEPFAR remains, they can only give PrEP to pregnant and breastfeeding women.
“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. “Hundreds of staff and the remaining programs from that are in the State Department, which is good news that PEPFAR exists and that global health still exists in the US government, but it doesn’t exist in an agency that thinks about people-centered care.”
One of the programs affected by USAID defunding is the Tangerine Clinic in Thailand, a transgender-focused health clinic. The clinic, which was fully funded by USAID since its inception in 2015, has seen at least a 20% decrease in clients since the defunding happened, largely because clients must now pay for their services. The clinic is currently trying to close mental health gaps, since they have lost staff members and have seen depression and suicidality in at least 20% of clients.
Felix Mugaka, MBChB, a research scientist from the Kenya Medical Research Institute, discussed a project where HIV prevention is being delivered alongside contraception and STI testing within retail pharmacies in Kenya. Mugaka explained that retail pharmacies offer a solution to barriers found in government clinics, such as long waiting times and limited operating hours. As a result, approximately half of people in sub-Saharan Africa go to retail pharmacies as their first point of care. This is especially true for the approximately 40% of women in Kenya seeking contraception and emergency contraception, since many public healthcare settings do not offer emergency contraception.
“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,” Deborah Anderson, Ph.D., professor at Boston University Chobanian & Avedisian School of Medicine, said during the presentation.
“We can’t go back to January 19,” Warren concluded. “We’ve just had a series of massive quakes, and we’ve got to now build differently.”