Bridging an Inexplicable Divide: Integrating Reproductive Health Services and the Global HIV/AIDS Response

This article from a series on global AIDS issues published by the RH Reality Check website marks World AIDS Day 2009 with an opinion piece on the United States (US) response to integration of family planning (FP)/reproductive health (RH) services and HIV and AIDS prevention and treatment (subsequently referred to as RH-HIV integration). It describes an imaginary scenario of two US government health projects in sub-Saharan Africa that refer clients to each other. One of those is a group of health clinics focusing on FP/RH, and the other is a network of voluntary HIV counselling and testing centres.

The author, Dr. Jeffrey Sturchio, further outlines the scenario of integrating "family planning and HIV/AIDS by having a family planning doctor actually working in the HIV counseling and testing centres. The same organization would then train family planning providers to offer HIV counseling and testing in other countries." However, he suggests that this scenario is rare, and that HIV and AIDS treatment and prevention efforts are not fully addressing the challenges of the epidemic in large part "because of inexplicable policies that have hindered full integration of HIV/AIDS and reproductive health programmes."

Dr. Sturchio recognises the successes of the bipartisan US President’s Emergency Plan for AIDS Relief (PEPFAR) as an emergency plan but finds that its recent reauthorisation (2008) falls short of "explicitly stating family planning as a key component in the effort to prevent new infections. This omission directly affects the development of country operating plans and the flexibility of HIV prevention funding intended to meet the greatest needs. Another barrier is the anti-prostitution pledge - a requirement that organisations receiving US funds publicly state their opposition to prostitution in order to continue their work fighting HIV/AIDS. The Department of Justice in July temporarily withdrew its appeal of a court injunction prohibiting enforcement of the pledge - a welcome action that should be accompanied by clear guidelines upholding the free speech rights of organizations."

While the article sees better HIV prevention possibilities in the RH-HIV integration efforts that can now proceed with less restriction from US funding, there may be barriers created by "the laws and policies of other countries that interfere with effective HIV/AIDS programs by further entrenching stigma, violating human rights and driving vulnerable populations away from HIV-related services. Harsh criminal penalties on groups at higher risk for HIV infection - such as men who have sex with men and sex workers - are human rights violations and must be viewed as such."

Dr. Sturchio calls for policymakers to unite behind evidenced-based interventions that promote RH-HIV integration programming. In the coming year, he calls for the following:

• "The global community through the U.N. [United Nations] and other forums clearly speaks out against laws and policies that further stigma and violate rights of people living with and affected by HIV and AIDS.
  
• Family planning and gender considerations are integral aspects of the program guidance PEPFAR managers send to and use in the field.
  
• The Global Health Initiative is robustly funded and has clear mandates on RH-HIV integration.
• Congress and the Obama Administration permanently put to rest the Anti-Prostitution pledge and Global Gag Rule."

He concludes that integrating RH and HIV services remains one of the strongest and as yet underutilised tools for prevention of further HIV infection.