Janet Fleischman
Senior Associate, Global Health Policy Center
The world's HIV/AIDS leaders are gathering in Washington, DC this week under the theme "turning the tide together." Yet the hope and optimism around creating an "AIDS-free generation" needs to be channeled into critical strategies that could make an immediate difference for women and girls.
The President’s Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women’s health will require integrating HIV/AIDS services with family planning and reproductive health services. I was recently in Tanzania, where the results of U.S. health investments indicate that this is a feasible and cost effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities.
Many lessons are being learned in Tanzania that should inform the scale up of integration under PEPFAR. Despite the politics that surround discussions of family planning in the United States and the challenges of integrating vertical programs, there is broad consensus among health experts that HIV and family planning services should be closely linked and that advancing integration is a smart and effective way to expand the impact of U.S. health investments.
Support for using the PEPFAR platform to provide more comprehensive health services for women, and specifically for family planning, has gained momentum in recent years. Growing evidence demonstrates the important program synergies and health benefits that flow from these linkages. As more women living with HIV access anti-retroviral treatment (ARVs), the HIV platform can be leveraged to provide important information and services they need to decide the number and timing of their pregnancies. Importantly, this approach includes preventing new HIV infections by reducing unintended pregnancies, thereby preventing mother-to-child-transmission (PMTCT). Similarly, integrating HIV prevention and treatment services into family planning and maternal child health programs is critical; this helps prevent HIV infection in women and girls, while increasing access for HIV-infected women to ARV treatment and to PMTCT programs to help ensure that their children remain uninfected
In Tanzania, the U.S. has made important commitments to provide a more complete range of health services for women and girls, through PEPFAR, USAID’s Office of Population and Reproductive Health, and the U.S. bilateral program activities – all of which fall under the Global Health Initiative (GHI). Whatever the future of the GHI, the U.S. government agencies should continue the momentum on integration by leveraging the PEPFAR platform to support linkages with family planning and reproductive health.
However, many challenges remain in pursuing integration. In Tanzania, challenges include the large unmet need for family planning among HIV-positive and HIV-negative women; chronic stock-outs of family planning commodities; the need for training and ongoing support for both HIV and family planning providers to ensure quality integrated services; and the severe shortages of health workers. For the U.S. government, challenges revolve around galvanizing domestic bipartisan support for family planning-HIV integration in the current polarized environment, and ensuring that such integration is prioritized and measured. Underlying all these challenges is the need to ensure that the rights of women and girls are respected.
Sustaining progress in Tanzania will require continued focus on certain key areas: political and financial commitment from the national government; training of HIV and family planning providers to deliver quality, integrated services; and targeted donor resources to promote family planning-HIV integration as a core component of HIV programs. By supporting family planning-HIV integration as part of more comprehensive health services, PEPFAR can advance its HIV/AIDS goals while contributing to better health outcomes for women and girls in Tanzania.
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