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NEWS IN CONTEXT

Advancing an Integration Agenda

August 4, 2008

The XVII International AIDS Conference in Mexico City opened on Sunday, August 3, bringing together 25,000 scientists, activists, program implementers and people living with HIV to discuss the state of the epidemic. Featured at a number of conference sessions and events is the integration of HIV prevention and sexual and reproductive health services—an issue that the Guttmacher Institute itself highlighted in a satellite session it organized for Sunday afternoon.

Guttmacher’s Heather Boonstra opened the session with a discussion of the broad global consensus on the need for—and the broad benefits of—linking HIV prevention and sexual and reproductive health services. However, the United States remains a notable exception to this consensus. Driven in large part by ideological opposition from social conservatives in the U.S. Congress and the Bush administration, the U.S. government has failed to acknowledge these benefits in its own global AIDS program, PEPFAR.

Boonstra was joined by a panel of experts with backgrounds in advocacy, policy, research and on-the-ground programs to discuss how sexual and reproductive health services, including family planning, can strengthen and complement HIV prevention efforts.

Morolake Odetoyinbo provided a powerful and passionate perspective from the vantage point of a person living with HIV in Nigeria. Speaking on behalf of the Global Network of People Living with HIV/AIDS (GNP+), she described a situation in which health care workers, society and even family members of people living with HIV often assume that sexual and reproductive life stops with an HIV diagnosis. She drew on her personal experience to highlight many of the daily challenges HIV-positive women face, including laws that prohibit adoption by HIV-positive people, to make the case for policies that acknowledge the needs of people living with HIV and support greater integration of HIV care and comprehensive sexual and reproductive health services.

The second panelist, Rose Wilcher of Family Health International, provided a compelling overview of the evidence showing that meeting the contraceptive needs of HIV-positive women is essential to global HIV prevention efforts, calling contraception “the best kept secret in HIV prevention.” She stressed that effective contraception for HIV-positive women who do not wish to become pregnant not only prevents the infection of infants, it decreases the number of future orphans and helps women achieve their own childbearing goals.

Anna Miller of the Elizabeth Glaser Pediatric AIDS Foundation followed with a hands-on perspective on current efforts to integrate sexual and reproductive health services into programs to prevent mother-to-child transmission of HIV. Like the other panelists, she described the need for ensuring that women have healthy pregnancies and access to a wide range of services, from syphilis and cervical screening to postnatal contraceptive services. Miller stressed that the distinctions between HIV and sexual and reproductive health policies and programs are often artificial and that the global community must recognize the common cause and the common areas of work between the two program areas.

Wrapping up the panel discussion, Boonstra reviewed the recent Congressional debate over integration in talks on reauthorizing PEPFAR. Using PEPFAR as an example, she highlighted the many challenges in the policy arena, from taboos around sex, contraception and abortion to a fundamental lack of understanding of the benefits of integration for the lives of HIV-positive individuals.

Boonstra closed by noting that much work remains to be done on integration, even though the world — if not the United States government — is moving in the right direction. Not only is integration the right thing to do for people living with HIV, it is also an integral step toward stemming the global AIDS epidemic.