The imperative for family planning in ART in Africa

Abstract

A massive and extremely ambitious initiative is underway to provide antiretroviral therapy to millions of patients with HIV in the developing world especially Africa very quickly. Recognising the need for simplicity in such resource-poor settings WHO guidance calls for one of four first-line tripletherapy alternatives—each with two nucleoside reverse-transcriptase inhibitors (NRTIs) and one non-nucleoside reverse-transcriptase inhibitor (NNRTI). In addition to supplying antiretrovirals in mass amounts major challenges include: identifying willing patients at the later stages of HIV infection when antiretroviral therapy is appropriate; overcoming AIDS-related stigma; ensuring adherence to the regimens; and providing sustained care and follow-up. In the middle of efforts to provide antiretrovirals rapidly on such a grand scale important needs such as family planning risk being overlooked. However ensuring that contraception is available to women on antiretrovirals is crucial— not only for the well-being of women and children but also as a potent instrument to combat AIDS. In Africa HIV is mostly transmitted heterosexually and women are somewhat more likely to be infected than men. Although women of reproductive age make up about 20% of the population they are 53% of the HIV-infected population. Therefore as the provision of antiretroviral drugs advances we must pay heed to important problems facing women. (excerpt)