Family planning and HIV: strange bedfellows no longer

Abstract

Women of reproductive age are disproportionately affected by the HIV/AIDS epidemic especially in sub-Saharan Africa where women account for nearly 60% of people living with HIV[1].Consequently the family planning and HIV fields intersect in a number of crucial ways: (1) Many women are simultaneously at risk for both unintended pregnancy and HIV infection. Countries with the greatest burden of HIV also have high levels of unmet need for family planning [2]. (2) Like all women HIV-positive women have a right to make reproductive decisions free of coercion. (3) For women with HIV who want to become pregnant use of antiretroviral prophylaxis during pregnancy can reduce mother-to-child transmission of HIV. Afterwards family planning services that promote healthy timing and spacing of pregnancies are important to reduce the risk of adverse pregnancy outcomes such as low birth weight preterm birth and infant mortality [3-5]. (4) For women with HIV who do not wish to become pregnant family planningis a proven cost-effective strategy for preventing mother-to-child transmission of HIV (PMTCT) and therefore reducing the number of children needing HIV treatment care and support [26-9]. (5) Barrier methods of contraception -namely male and female condoms -can protect against both unintended pregnancy and sexual transmission of HIV. (6) HIV services provide an opportunity to reach women and men at risk of and living with HIV with family planning information and services. (7) Family planning services particularly in generalized epidemics provide an opportunity to increase access to HIV counseling and testing and other HIV services. However rather than being natural allies family planning and HIV have remained strange bedfellows [1011]. Despite the established connections between the fields they are not effectively bridged in practice. Rates of unintended pregnancies remain alarmingly high in women with HIV and family planning interventions have been underutilized in HIV prevention care and treatment programs [12-14]. In addition HIV programs have emerged primarily as separate silos and only minimal efforts have been made to leverage and integrate them with existing family planning infrastructures. This supplement originated from the belief that more evidence is needed to compel funders policymakers program planners and implementers to act on the synergies between the two fields and enhance the public health impact of reproductive health and HIV programs. The contents of this supplement represent research being conducted within three broad areas: behavioral research examining contraceptive practices and fertility desires of HIV-positive women and couples; biomedical research addressing the safety and effectiveness of contraceptive methods for HIV-positive women; and programmatic research evaluating service delivery approaches to integrating family planning and HIV services. Taken together the studies published in this supplement expand the evidence base regarding how the family planning andHIV fields are related and how they can be better integrated in practice.