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Dr Alvaro Bermejo Headshot

Integration, Integration, Integration!

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Let's talk about sex.... At the third Women Deliver conference in Kuala Lumpur this week, that's pretty much what we have been doing non-stop for three days! Surprisingly though there has been very little focus on pleasure and sexuality. As a doctor, I'm all for promoting the clinical and medical side of healthcare but shouldn't we also be celebrating enjoyment for enjoyment's sake?

For all the talk this week of women's rights, of sexual and reproductive health, and of gender equity, there have been a couple of noticeable omissions. Among the thousands of delegates, including Melinda Gates and Chelsea Clinton, there has been very little representation of either transgender women or sex workers. It's almost as if there's been an unspoken agreement to focus on the reproductive rights of "good women" and gloss over the complex needs of the more marginalised.

Our starting point must be with those who are least powerful, those that have least access to services. We can't keep talking about sex education without it specifically addressing diversity. Last night I met with a group of Kuala Lumpur sex workers who are supported with HIV prevention and awareness outreach by our partner, the Malaysian AIDS Council. Sex workers here, and in particular transgender sex workers, often experience severe stigma from medical professionals when trying to access healthcare services. It's a great shame then that their voices weren't heard this week as unless we acknowledge the rights of vulnerable groups at most risk of HIV, we will find ourselves with an unfinished agenda when it comes to the sexual and reproductive health of women and girls the world over.

But I don't want to be the party pooper at what has been a very upbeat summit, full of optimism at the progress made in recent years on women's issues, for want of a better catch-all. When the Millennium Development Goals (MDGs) were set back in 2000, sexual and reproductive health (SRH) didn't even figure prominently; it wasn't until seven years later that it was recognized that the other goals to eradicate global poverty wouldn't be achieved without specific SRH targets. Today, as we await the unveiling of the new post 2015 development framework in the report being published by the UN high level panel, chaired by David Cameron, there's little doubt that this is an issue that has grown in significance and is currently championed by both the Foreign Office and the Department for International Development.

And rightly so. Nobody in their right mind would question the validity of what improving women and girls' sexual and reproductive health means in real terms - just imagine the knock on effect on education, employment, empowerment - but we do need to get savvier at how we tie everything up together. For me, this week has thrown into sharp focus the fact that MDGs 3, 4, 5 and 6 (taking in gender equality, child and maternal health, HIV and other diseases) are in effect joined at the hip. If we in the development sector are serious about ending poverty, we need to come out of our silos and our comfort zones and, to paraphrase Tony Blair, knuckle down to integration, integration, integration!

We also need to pay community activism its dues and give it the space to thrive. One of the reasons the HIV response has been so successful in some places is down to the drive and sense of purpose of community leaders who have fought for so long for treatment, care and prevention services. This has been the case too in the sexual and reproductive health arena, in water and sanitation, in malaria, in so many other arms of this many tentacled octopus we call international development. If we can play a greater role in bringing natural leaders together to advocate jointly for change, then that really would be the power of we in action.