Laws and policies
HIV responses and universal health coverage
Chapter 5: Sustainable, people-centred approaches


HIV counselling and testing services are integrated with sexual and reproductive health services in ALL OR SOME HEALTH FACILITIES in nearly all reporting countries.

24% OF NEW HIV INFECTIONS IN CHILDREN in 2019 were linked to mothers losing access to HIV care either during pregnancy or breastfeeding

Preventive treatment for tuberculosis was provided to 1.8 MILLION PEOPLE LIVING WITH HIV in 65 high-burden countries in 2018

JUST 53 COUNTRIES reported in 2019 that their national policies included explicit supportive references to harm reduction

ONLY 56 OF 99 COUNTRIES with recent data from sex worker surveys showed that at least 80% of respondents reported condom use at last paid sex

Health systems must manage an increasingly complex array of communicable and noncommunicable diseases with finite human and financial resources. The COVID-19 pandemic has laid bare the need for systems to be more resilient, flexible and adaptable, and to provide everyone with the services they need in a more effective way. Accelerated movement towards universal health coverage can help health systems achieve the highest possible standards of health and well-being for all people.

The Lancet Global Health Commission on High Quality Health Systems in the SDG Era found that health systems across the world were operating inefficiently, largely due to fragmented services that also compromise the quality of care provided. It is estimated that approximately 8.6 million deaths per year in low- and middle-income countries (including almost 300 000 among people living with HIV) could be attributed to the less-than-ideal functioning of health systems. Deeper integration across programmes and services can help health systems become flexible and resilient enough to manage shifting and interlinked burdens of disease, sudden epidemic outbreaks and other emerging health challenges.

However, integration is not a solution for all health service shortcomings. Health and HIV services must also be people-centred, responding to the needs of the individuals who require those services the most. The previous chapter highlighted the importance of addressing the determinants of health, and how layered approaches that reach beyond the health sector help reduce HIV risk among adolescent girls and young women. This chapter presents additional evidence that a combination of more integrated and more people-centred approaches improves service uptake and health outcomes for children living with HIV, adolescent girls, young people and women.

People-centred approaches also better respond to the needs of people at higher risk of HIV infection, such as sex workers, people who inject drugs, transgender people, prisoners and gay men and other men who have sex with men. Ensuring that health and HIV programmes reach migrants and refugees is also important from the perspective of both human rights and public health. Efforts to maintain health services during COVID-19 lockdowns have underscored the value of differentiated services, including community-led services that are grounded in lived realities and responsive to the needs, priorities and rights of most-affected populations.