World AIDS Day presents an opportunity to examine where we stand in the struggle against HIV/AIDS. One clear area of progress is the high degree of consensus at the global level that better linkages between HIV and reproductive health services are key both in meeting the needs of HIV-positive women and men and in preventing HIV transmission.
A solid body of evidence now demonstrates that these linkages are especially important in countries with high HIV prevalence and weak health infrastructures. It makes eminent sense to offer sexually active women the services they need—whether related to HIV or to reproductive health—in settings they already frequent. Women should be able to receive HIV testing, counseling and referrals at sites that they visit regularly to obtain family planning services. In turn, they should be able to obtain family planning counseling and services to help them to avert pregnancies they don’t want at places they visit to receive HIV services.
But while the global community recognizes the crucial role of linking these services, U.S. policy lags. Unaccountably, the law that guides the U.S. global AIDS program (PEPFAR), although revised and reauthorized little more than a year ago, fails to mention these linkages at all.
In fact, U.S. policy—unquestionably strong in the AIDS treatment area—lags generally in terms of HIV prevention. In no area is this more so than in its failure to adequately meet the needs of young people. PEPFAR still overemphasizes abstinence as the officially preferred strategy to prevent sexual transmission of HIV among all unmarried people, and imposes many restrictions on young people’s ability to receive comprehensive sex education and to obtain condoms.
Notably, however, PEPFAR now provides significantly more flexibility in implementation than it did in the past. This means it is largely up to the Obama administration to determine what specific kinds of programming will most effectively achieve U.S. goals. Advocates are hopeful that PEPFAR’s program guidelines will be rewritten to move U.S. policy decisively toward embracing HIV¬–family planning linkages and more forthrightly meeting the needs of young people at risk of HIV infection.
The United States has been and remains the single largest contributor to HIV and AIDS programs overseas, and U.S. policy is critical in shaping health and development programs for youth worldwide. Policy experts and advocates eagerly await the elimination of obstacles hampering PEPFAR’s ability to support the most effective interventions. New and more enlightened guidelines are long overdue.
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