Maria de Bruyn is the Senior Policy Advisor for Ipas.

On 9-10 October 2006, Addis Ababa University and the Gates Institute for Population and Reproductive Health organized an interesting conference for over 480 participants in Addis Ababa, Ethiopia: "Linking Reproductive Health and Family Planning with HIV/AIDS Programs in Africa." As is often the case at such meetings, useful information was shared that led to more questions needing answers.

A number of presentations investigated the fertility intentions of people living with HIV/AIDS. Researchers reporting on studies from Botswana, Ethiopia, Malawi, Namibia, Nigeria, South Africa, Tanzania and Uganda indicated that HIV-positive women (and men) often want to continue having children. Not surprisingly, however, considerable numbers of women living with HIV also do not want (more) children – especially if they are already mothers, are somewhat older and not in a relationship with a new partner. Sadly, numerous studies also reported an unmet need for family planning among HIV-positive individuals, which is resulting in unwanted pregnancies. One study among people receiving antiretroviral therapy at a large clinic in Ethiopia, for example, found that unsafe abortion was a problem for their female clients.

Several research groups gave presentations on the feasibility of integrating reproductive-health/family-planning counseling into HIV/AIDS services and vice versa. While HIV-positive clients (and researchers) consistently endorsed such integration, they often encountered problems such as a lack of appropriate knowledge on the part of providers and insufficient staff numbers to promote integration. A particularly interesting paper from the Constella Futures Group highlighted the need to address policy issues before integration of such services is begun (e.g., are health systems structured in a way that supports integration or linkages?).

What was striking about the discussions was that little mention was made of creating linkages between HIV/AIDS and postabortion care/legal abortion services, despite the reports on unintended pregnancies. Employing (paying!) trained HIV-positive persons as reproductive-health/family-planning counselors, to help alleviate staff shortages and contribute to services more oriented to client needs, was also scarcely raised as a strategy during a working group on needed policy change. Ipas advocated for more meaningful involvement of people living with HIV in the design, implementation and reporting of studies dealing with the reproductive health of HIV-positive persons. During the meeting we shared a presentation of our own work with Jennifer Gatsi, a member of the International Community of Women Living with HIV/AIDS (ICW), who collaborated on a study with us in Namibia. Startlingly, Jennifer was the only HIV-positive person to present research findings at the conference.

The presentations and working group outcomes from the conference will be made available soon through this website.