Family planning, AIDS care should go hand in hand


Twenty-five years into the AIDS epidemic and halfway through the initial phase of the President's Emergency Plan for AIDS Relief, there is increasing international consensus about the need to target women and girls. One area where the U.S. could make a real difference in women's lives has until recently been largely overlooked: integrating HIV/AIDS and reproductive health services. This presents important new opportunities for the U.S. AIDS program to become more effective and sustainable.

The International AIDS conference Aug. 13-18 in Toronto is an opportune moment for the U.S. and its partners to make this integration a higher priority.

More than 80 percent of HIV infections worldwide are sexually transmitted. Addressing reproductive health and HIV together would better serve the needs of clients and health care providers in a more comprehensive, cost-effective and efficient manner. This makes sense when you consider how women interact with the health system. Sexually active women who seek family planning need information about how to protect themselves from HIV infection, or how to access HIV services if they are infected. Women who seek an HIV test or who are already receiving HIV treatment need information about reproductive health and family planning, so they can make informed choices about contraception, childbearing, and staying healthy.

The benefits of integrated programs also serve U.S. policy goals on AIDS care, prevention and treatment. Integration helps reduce the number of babies born HIV-infected as well as the number of future AIDS orphans, while also keeping the mothers healthier and alleviating the burdens on families and communities. This is accomplished by expanding opportunities for women to learn their HIV status, providing treatment for HIV-positive pregnant women to prevent HIV transmission to their infants, and increasing family planning for HIV-positive women to prevent unwanted pregnancies.

During a recent trip to Kenya, where I was investigating promising integrated programs, an official of a U.S.-based organization in Kenya explained why integration makes sense to reach women and girls at risk: "When we think about HIV and reproductive health issues, it boils down to one thing: People have to have sex if they're going to get HIV, STIs, unplanned pregnancy. They have to have unprotected sex - it's the common denominator."

Inevitably, some U.S. policymakers will be uncomfortable with the premise of integrating reproductive health and family planning into HIV/AIDS programs, if they assume that "reproductive health" is merely a euphemism for abortion services. Yet reproductive health covers a broad range of women's health issues, including detection and treatment of sexually transmitted infections, and support to HIV-positive women who want to have children safely.

With women and girls so acutely vulnerable to HIV infection, the U.S. has ample motivation - for both ethical and operational reasons - to ensure that its AIDS programs recognize and address emerging gaps in treatment, care and prevention services. For both ethical and operational reasons, women and girls accessing HIV testing and treatment through U.S.-funded programs have a compelling need for reproductive health services, just as women and girls accessing reproductive health services have a critical need for HIV information and services.

Although integration is a logical step for U.S. AIDS programs, it has only recently begun to emerge as an important issue. At this stage, a few U.S. programs have begun promising innovations that integrate reproductive health or family planning with HIV programs. However, most programs do not yet acknowledge the importance of linking reproductive health and HIV/AIDS, even though these issues are gaining prominence in AIDS programs elsewhere. U.S. AIDS officials must identify the barriers to integration and make the necessary adjustments in policies and programs.

To its credit, over the past year, the U.S. AIDS program has demonstrated a greater rhetorical commitment to addressing issues specific to women and girls. But the epidemic's impact on women and girls demands more innovation.

At the Toronto AIDS Conference, the U.S. has an opportunity to move forward a global effort to better reach women and girls by supporting funding for integrated programs and promoting efforts to achieve results. Otherwise, as I was told in Kenya, "what we're doing is like mopping the floor while the roof is leaking."

Janet Fleischman is a senior associate at the Center for Strategic and International Studies HIV/AIDS Task Force. She recently published "Integrating Reproductive Health and HIV/AIDS Programs: Strategic Opportunities for PEPFAR."

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