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 health services.
The 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 goals.
Anna Miller 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.
