Contraceptive Services a Major HIV Prevention Strategy Mostly Overlooked by Policymakers

Helping HIV-Positive Women Avoid Unintended Pregnancy Means Fewer Unplanned Births and HIV-Infected Infants

Integrating the provision of voluntary contraceptive services into programs where HIV-positive women are going for HIV-related treatment is essential to make U.S. efforts to combat the AIDS epidemic more effective, according to a new Guttmacher Institute policy analysis. Unintended pregnancy prevention is a critical, but largely overlooked, component of any prevention strategy since so many HIV-positive women wish to delay or prevent pregnancy, the analysis finds.

"As U.S. policymakers consider the future shape of the U.S. global AIDS program, known as PEPFAR, they should listen to public health experts and incorporate prevention into treatment programs, with voluntary contraceptive services as a core component of these prevention efforts," says Susan Cohen, author of the policy analysis. "This would make it easier for HIV-positive women to coordinate their HIV treatment with their pregnancy prevention goals. Making modern contraceptives more easily accessible could significantly decrease the number of new infections by helping women who may consider themselves too sick to carry a pregnancy or have another child to avoid unintended pregnancies and unwanted births."

Women of reproductive age comprise more than half of the 33 million people living with HIV around the world. But currently, programs designed to help prevent the transmission of HIV from mother to child only reach about one in 10 eligible women in poor countries. Meanwhile, a large number of women in these programs say that their pregnancies were unintended.

"A recent report from the U.S. Centers for Disease Control and Prevention, for instance, found that 93% of the pregnancies among pregnant women receiving antiretroviral drugs in Uganda were unintended," says Cohen. "While we need to do better in getting more HIV-positive pregnant women into treatment programs for themselves and for their newborns, we can also do much more to help these women avoid unintended pregnancy in the first place by making contraceptives more easily available. It’s a win-win—helping HIV-positive women avoid unintended pregnancy not only lowers the rate of new infections while helping them to achieve their own childbearing goals, it does so at a relatively low cost."

Current PEPFAR guidelines already require family planning counseling and referral as one of four elements comprising the minimum package of services for preventing mother-to-child transmission. But the program does not provide contraceptive services directly, thus forcing women in countries with poor health infrastructures either to seek contraceptives elsewhere or to forego their use altogether.

As Congress embarks on the process to renew PEPFAR, social conservatives are mounting strong opposition to updating PEPFAR so that it could pay for contraceptive services for HIV-positive women.

"This opposition ignores the strong evidence of contraception’s effectiveness as an HIV prevention intervention," says Cohen. "It also ignores that the major implementers of programs to prevent mother to child HIV transmission are calling for the integration of contraceptive services into PEPFAR. And most of all, it completely disregards the women themselves who are requesting these services."

"This issue is not academic nor should it be political. It is a practical reality," says Cohen. "Many lives are at stake, and it’s high time for policymakers to shed their ideological blinders and allow PEPFAR to be the best public health program it can be."

Click here to read "Hiding in Plain Sight: The Role of Contraception in Preventing HIV," by Susan A. Cohen, to be published in the forthcoming Winter 2008 issue of the Guttmacher Policy Review.

Click here for more information on:

Meeting the sexual and reproductive health needs of people living with HIV

The role of reproductive health providers in preventing HIV

Renewing the focus on prevention in U.S. global AIDS policy

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