Costs and benefits of community responses for sexual and reproductive health and the societal enablers: a scoping review

BACKGROUND: Evidence shows that promoting community leadership and creating rights-protective environments increases the effectiveness of other interventions aimed at ending HIV and preventing deaths from AIDS. This evidence underpinned the adoption by UNAIDS of the community-led service delivery components of the 95-95-95 targets and the 10-10-10 societal enabler targets. Although progress on these two sets of targets is fundamentally interdependent they are commonly assessed in isolation from one another. Because of this, we have integrated the literature on the costs and benefits of these interventions and set their findings in dialogue and contestation with another.
METHODS: Focused on HIV/AIDS as well as the sexual and reproductive health rights (SRHR) of key and vulnerable populations, our research is based on three interrelated scoping reviews on (1) benefits of policy and social environments that promote SRHR; (2) the costs of criminalisation, discrimination and stigma that run contrary to SRHR; and (3) the costs/benefits of community services addressing SRHR.
RESULTS: Using a mapping of the key concepts, research, and evidence gaps in literature, we have procedure a broad synthesis of the costs, benefits and resources required for community led service delivery and societal enabler policies that promote SRHR in the context of HIV/AIDS. then analyse commonalties, distinctions, and research gaps. Preliminary findings indicate broad consensus in favour of the cost-effectiveness and other benefits of the interventions and policies under review for which there is available evaluation as well as corollary evaluations of the costs and other harms from discrimination, stigma and criminalisation. economic evaluation and assessment, to give a broad indication of the findings in the literature. Through synthesis of our findings, we are still analysing shared benefits of progress the costs and cross-cutting costs of neglecting the interrelated targets set by UNAIDS while also assessing learns for the effectiveness of siloed targets.
CONCLUSIONS: Our findings provide a novel contribution to the literature and should help inform future research on the health and societal challenges experience by key and vulnerable population as well as provide evidence in favour of increased investments in community services addressing HIV-related SRHR, societal enablers and scaled-up community leadership.

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