Heather Boonstra is a senior public policy associate at the Guttmacher Institute. This blog post was adapted for Science Speaks’ Blueprint series, in which clinicians, researchers and advocates address the key elements they would like to see in the Global AIDS response blueprint that Secretary of State Hillary Clinton called at the 2012 International AIDS Conference in Washington, from a longer analysis published in the Fall 2011 issue of the Guttmacher Policy Review.
By Heather Boonstra
In her call for a blueprint by World AIDS Day 2012 to achieve an AIDS-Free Generation, Secretary Clinton said, “Every woman should be able to decide when and whether to have children. This is true whether she is HIV-positive or not.”
Women want to protect themselves from HIV, and they want “access to adequate health care,” including family planning, Clinton said, crediting the President’s Emergency Plan for AIDS Relief (PEPFAR) for its role as part of a comprehensive effort to meet the health needs of women impacted by AIDS.
Indeed, PEPFAR policies strongly endorse linkages between HIV and family planning programs in developing countries. At the same time, however, PEPFAR fails to ensure that women who make their way to HIV testing, care and treatment programs also have access to a range of contraceptives. Among other negative impacts, this failure is undermining the potential success of one of the most powerful and effective approaches to halting the epidemic: the prevention of mother-to-child transmission of the virus that leads to AIDS.
A global AIDS blueprint to bring about an AIDS-free generation must address this gap.
Although current PEPFAR policies endorse the use of PEPFAR funds for family planning counseling and referrals for contraceptives, they also prohibit the use of PEPFAR funds for contraceptive themselves, implicitly shifting responsibility to the U.S. Agency for International Development’s (USAID) family planning program. This gap is problematic in several respects:
- The USAID family planning assistance program is already hard-pressed to meet the ever-rising demand for family planning services and is under serious threat from future budget cuts;
- In addition, there are countries and regions within countries where a PEPFAR program exists, but with no complementary USAID family planning program.
The ongoing failure to link family planning and HIV services fully leaves PEPFAR policy out-of-step with UNAIDS recommended “four-pronged approach” to prevention of mother-to-child transmission, which includes the prevention of unintended pregnancies among HIV-positive women.
The blueprint can bring policy in line with good practice by recognizing family planning as a critical component to achieving an AIDS-free generation. Building on past investments, the blueprint should include language explicitly encouraging PEPFAR implementers to leverage HIV service delivery sites—such as HIV care, treatment and support programs and PMTCT programs—to also provide voluntary family planning counseling and services, either directly or by referral. Moreover, the blueprint should endorse the use of PEPFAR funds for contraceptives at least in those settings where women do not have access to these methods through USAID or other local family planning programs.
PEPFAR has come very far in recent years to encourage linkages between HIV services and family planning services. The blueprint should now go all the way, fully endorse the Secretary’s commitment to HIV-family planning linkages and ensure that every woman has access to all critical HIV prevention and care services, including access to contraceptives.