UNFPA - integration of reproductive health and HIV prevention services

The Caucus for Evidence Based HIV Prevention was set up for the Toronto World AIDS Conference in 2006, with the aim of pulling together evidence based models of prevention. It is re-forming and re-focusing on the Mexico World AIDS Conference this August.

The focus of this meeting was on models that integrated family planning services and HIV prevention - that is that all services providing family planning, maternal and child health services also provide HIV prevention interventions, and all HIV prevention services are at least linked, if not fully integrated with family planning services.

Research suggests that 25% of pregnancies in high HIV prevalence areas are unplanned. Increased access to contraception, family planning advice, women's health services, etc. can reduce the risk of HIV transmission by ensuring women have children when they want to, and have access to the full range of health services that prevent mother-to-child transmission. This has raised controversy, as some believe that this advocates abortion and stopping children being conceived at all, but the primary focus is on allowing women to have more control when they become pregnant.

Research on the benefits of this kind of integration is limited - it does suggest that communities where these services are at least linked, if not fully integrated, tend to have higher levels of awareness, and there is higher uptake in voluntary testing and counselling. But as few if any control trials have been undertaken, and studies on the impact on HIV prevalence, stigma, costs and cost benefit ratios have yet to be undertaken.

PEPFAR and Integration
While this was not a feature in the original PEPFAR programme, ongoing advocacy by the FPA and others has encouraged a recognition of the need for integrated or linked services. However both the religious right and the left wing HIV advocacy groups were antagonistic. On the right this was over the issues of abortion promotion and contraception, while the HIV movement did not see maternal and neonatal health issues as a priority and feared this would divert funding from prevention services among at risk marginalised groups such as commercial sex workers and MSM. As a result it has not been a major feature of the last PEPFAR renewal bills. But, while opposition remains, there is hope that this will feature on the next renewal bill. The problem seem to be a misunderstanding and mistrust of the language around reproductive health and family planning. The need for dialogue between all three camps would seem to be very important - the HIV and family planning sectors seem to be doing this, but religious groups need to be more active in working in this area and clarifying what services are provided when we talk about reproductive health.

It is also worrying to note that the US funding for all maternal health, child health and family planning services faces an 18% cut in 2009.

One of the FPA team raised the issue that integrated HIV and reproductive health services must address heterosexual men - the one group that tends to be left out of the discourse on HIV prevention, but who are at least 50% of the problem in achieving a reduction in HIV rates.