Our first day at the XVII International AIDS Conference here in Mexico City has been both
gratifying and frustrating. As with previous AIDS conferences, it’s been
thrilling to see the large number of people committed to fighting this deadly
disease. I was especially happy to see the large number of sessions and events
that promote closer integration of HIV prevention and sexual and reproductive
health services–an issue that the Guttmacher Institute itself highlighted with
the help of several other groups at a satellite session we organized and
sponsored on Sunday afternoon.
But there was also a good bit of frustration for us in seeing
the broad global consensus on the need for–and the broad benefits–of these
linkages at a time when the U.S. government remains reluctant to acknowledge
these crucial linkages in is own global AIDS program PEPFAR. That reluctance–driven in large part by
ideological opposition from social conservatives in the U.S. Congress and the
Bush administration–was the topic of my own presentation at our satellite
session. I was joined by a panel of experts with backgrounds in advocacy,
policy, research and on-the-ground programs to jointly explore how sexual and
reproductive health services, including family planning, can strengthen and complement
HIV prevention efforts. We put special emphasis on the importance of services
that address the sexual and reproductive health needs of those living with HIV.
The speakers drew on their personal and their organizations’
experience and expertise to address the varied benefits of, and challenges to,
integration. Morolake Odetoyinbo provided
a powerful and passionate perspective from the vantage point of a person living
with HIV in Nigeria.
Speaking on behalf of the Global Network of People Living with HIV/AIDS (GNP+)
she described a present situation in which health care workers, society and
even family members of people living with HIV often assume that sexual and
reproductive life stops with an HIV diagnosis. She drew on her personal
experience to highlight many of the daily challenges HIV-positive women face,
including laws that prohibit adoption by HIV-positive people, to make the case
for policies that acknowledge the needs of HIV positive people and support
greater integration between HIV care and comprehensive sexual and reproductive
second panelist, Rose Wilcher of Family Health International, provided a
concise and compelling overview of the evidence on
how meeting the contraceptive needs of HIV-positive women is essential to
global HIV prevention efforts–calling contraception "the best kept secret in
HIV prevention." She stressed that
effective contraception for HIV-infected women who do not wish to become pregnant
not only prevents infants from becoming infected, it decreases the number of
future orphans and, most of all, helps women achieve their own childbearing
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of the Elizabeth Glaser Pediatric AIDS Foundation followed with a hands-on perspective
on current efforts to integrate sexual and reproductive health services into
programs to prevent mother-to-child transmission of HIV. Like the other
panelists, she stressed the need for ensuring that women have healthy
pregnancies and access to a wide range of services, from syphilis and cervical
screening to post-natal contraceptive services. Anna stressed that the
distinctions between HIV and sexual and reproductive health are often
artificial and that we must recognize the common cause and the common areas of
work between the two program areas.
Wrapping up the panel discussion, I provided a review of the
recent debate over integration within the context of reauthorizing the U.S
global AIDS program PEPFAR. Using PEPFAR
as an example, I tried to convey to the audience the many challenges–from
taboos around sex, contraception and abortion to a fundamental lack of
understanding of the benefits of integration for the lives of HIV-positive
individuals–in the policy arena.
There certainly is much work left to be done on integration,
even though the world–if not the United States government–is moving
in the right direction. That’s why events such as the AIDS Conference and
Guttmacher’s satellite session are so critical in bringing together scientists,
activists, program implementers and people living with HIV to advance this
critical agenda. Not only is integration the right thing to do, but it’s also
an integral step toward stemming the global AIDS epidemic.