A series of policy guidances recently issued by the Obama administration strongly endorse linkages between HIV and family planning programs in developing countries, but a failure to ensure that women in HIV treatment programs have access to contraceptives is undermining efforts to integrate these two critical health services, according to "Linkages Between HIV and Family Planning Services Under PEPFAR: Room for Improvement," by Heather Boonstra.
The new guidances fully endorse the provision by family planning programs of HIV counseling and testing, as well as referrals for HIV care and treatment, and they recommend the use of President’s Emergency Fund for AIDS Relief (PEPFAR) funds for these purposes. The guidances also specifically acknowledge that preventing unintended pregnancy is vital to lowering the rate of new HIV infections. Therefore, they state, women in HIV programs should have access to family planning counseling and referrals for contraceptives.
However, PEPFAR funding for contraceptives themselves is prohibited, even in places where there is no corresponding family planning program available to which women can be referred. A substantial number of PEPFAR-funded countries that do not receive U.S. funding for family planning—including Botswana, Namibia and Swaziland—have HIV-prevalence rates that are among the highest in the world.
The benefits of more fully integrating family planning services into HIV programs would be profound for the substantial number of HIV-positive women who are at risk for unintended pregnancy and are in need of contraceptive counseling and supplies. Several studies conducted in Sub-Saharan Africa suggest that the proportion of pregnancies that are unintended among HIV-positive women in these programs ranges between 51% and 92%. Boonstra notes that the notion that PEPFAR should not fund contraceptives may appear appropriate, given that the United States has a separate funding stream dedicated to that purpose, but points out that the U.S. international family planning program—already struggling to meet the growing demand for services—is a prominent target among social conservatives for steep budget cuts.
At a minimum, Boonstra contends, the administration should have endorsed the use of PEPFAR funds for contraceptives at least in settings where women do not have access to a family planning program. The administration now has a responsibility to find ways to bridge this gap, ensuring that women have access to both the HIV services and the family planning care they need.
"Linkages Between HIV and Family Planning Services Under PEPFAR: Room for Improvement," by Heather Boonstra appears in the Fall 2011 issue of the Guttmacher Policy Review.