Every year, the U.S. Office of the Global AIDS Coordinator sends out what it calls Country Operational Plan (COP) guidance to embassies around the world. You could think of COP as a cop: It tells the hundreds and hundreds of U.S. government health experts the goalposts ahead, including a list of things that can’t be done.
One COP piece of guidance this year has caused some distress in the field: Family planning can be integrated into US HIV programs, but no US HIV/AIDS money can buy family planning commodities, including contraceptives, due to U.S. regulations.
So in some countries a woman receiving help in preventing transmission of HIV to her child during birth can’t later receive free contraceptives with money from the President’s Emergency Plan for AIDS Relief.
Eric Goosby, MD, the global AIDS coordinator, said in an interview with journalists Wednesday that he and his staff have been trying to find a way to allow women to be able to get those commodities. He said he is trying to sort through political and bureaucratic issues.
“It is a bigger issue than I appreciated when I took this job,” he said. “We are closing the gap almost completely for the availability of those services. I was not happy with the availability of those services initially, but USG [U.S. government] and other country funding around family planning issues have allowed us to find services in places where we’re at. But the chapter hasn’t closed on it.”
He said the Obama Administration would continue to work on the issue, but it could take into next year to get the matter resolved.
Goosby became animated in talking about the high fertility rates in many poor countries, especially in sub-Saharan Africa.
“We have fertility rates of five to 14 [children] per woman in the countries we work in,” Goosby said. “Per woman! Just think about that for a little bit and think what that means to this HIV-positive woman who’s got children at home to care for already, is now pregnant with another one. And it reverberates in the economics and the partner relationship, and [the burden] mostly falls on the woman.”