This paper explores PEPFAR guidance on creating and strengthening linkages between HIV and family planning services. It also highlights weaknesses of the current policy, including the current prohibition of use of PEPFAR funds for contraceptives and the gaps that exist in a number of countries where there are PEPFAR treatment programs but not corresponding U.S. family planning programs.

The objectives of this updated guidance are to: Highlight importance of integration for PEPFAR PMTCT, pediatric HIV, and MNCH program support Identify an essential package of integrated PMTCT / pediatric HIV / MNCH services and health systems strengthening activities Recommend possible action steps to operationalize and evaluate integration efforts.

Described as the foundation upon which the Global Health Initiative (GHI) rests, the President’s Emergency Plan for AIDS Relief (PEPFAR) is undergoing significant change. HIV/AIDS prevention, care and treatment remain the focus of PEPFAR, yet the GHI mandates that PEPFAR—along with the rest of the U.S. government’s global health portfolio—take a more holistic approach to meeting individuals’ primary and preventive health care needs, especially for women and girls, with family planning/reproductive health chief among those.  

In recent proposal rounds, The Global Fund for AIDS, Tuberculosis and Malaria (GFATM) has stated explicitly that countries can include reproductive health as part of their proposals on AIDS, tuberculosis, and malaria, as long as they provide a justification to show how reproductive health (RH) has an impact on one of these three diseases.

The International Conference on Population and Development established the effective prevention and treatment of sexually transmitted infections, including HIV, as an integral component of reproductive health services. There are clear interactions between reproductive health and HIV/AIDS, most HIV infections being sexually transmitted or associated with pregnancy, childbirth and breastfeeding. In addition, reproductive ill-health and HIV/AIDS share root causes, including poverty, gender inequality and social marginalization of the most vulnerable populations.

This plan emerged from a Special Session of the African Union Conference of Ministers of Health, which was held in Maputo, Mozambique from September 18-22, 2006. The plan's ultimate goal is for African governments, civil society, the private sector, and all development partners to join forces to achieve universal access to sexual and reproductive  health in all African countries by 2015.     

UNFPA and UNAIDS, in collaboration with Family Care International, convened a high-level global consultation at the Rockefeller Foundation in New York in 2004. Participants, including ministers, parliamentarians, ambassadors, leaders of United Nations and other multilateral agencies, donor organization officials, community and nongovernmental organization leaders, young people, and people living with HIV made the following call to commitment.

Family planning and HIV integration is an important strategy for addressing the reproductive health rights and needs of women living with and at risk of HIV. Policy support for stronger linkages between family planning and HIV programs is growing, and field-based integration efforts are expanding. As policy and programmatic momentum builds, more evidence of effective integrated service delivery practices are needed to guide scale-up.

Voluntary contraceptive use by HIV-positive women currently prevents more HIV-positive births, at a lower cost, than anti-retroviral drug (ARV) regimens. Despite this evidence, most prevention of mother-to-child transmission (PMTCT) programs focus solely on providing ARV prophylaxis to pregnant women and rarely include the prevention of unintended pregnancies among HIV-positive women.

International policy statements and supportive policies from donors and national governments can help provide the justification for establishing or strengthening the linkages between family planning and HIV/AIDS. An increasing array of guidance documents and tools are available to help translate policy support into practice. Normative bodies and international agencies should continue to endorse linkages between FP and HIV/AIDS while countries bolster efforts on the ground through policy support, dissemination, and implementation.

The Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo in 1994 offers a comprehensive framework for achieving sexual and reproductive health and rights, including the prevention and treatment of HIV/AIDS, and for advancing other development goals. The United Nations Millennium Development Goals now incorporate a target of universal access to sexual and reproductive health within the goal of improving maternal health, but combating HIV remains a separate project with malaria and tuberculosis.

This article highlights five reasons why integration is a sound investment that will pay multiple dividends for individuals, communities, societies, and health systems.

This paper considers new developments to strengthen sexual and reproductive health and HIV linkages and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these linkages. We argue that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved significant scale-up of integrated service provision.

Many governmental and nongovernmental public health agencies are pursuing and, in some cases, scaling up programs that integrate family planning (FP) and HIV services. In response to calls from public-health decision makers for guidance on FP/HIV integration, the World Health Organization, the U.S. Agency for International Development, and Family Health International developed Strategic Considerations for Strengthening the Linkages between Family Planning and HIV/AIDS Policies, Programs, and Services.

BACKGROUND: Most efforts to prevent mother-to-child transmission of HIV have focused on provision of antiretroviral prophylaxis to HIV-infected pregnant women. Increasing voluntary contraceptive use has been an underused approach, despite clear evidence that preventing pregnancies in HIV-infected women who do not wish to become pregnant is an effective strategy for reducing HIV-positive births.

The revised fourth edition of this evidence-based guideline reviews the medical eligibility criteria for who can safely use a contraceptive method. It offers guidance on the safety of using 19 different methods for women and men with specific characteristics or known medical conditions. The recommendations are based on systematic reviews of available clinical and epidemiological research.

This 2008 update of Selected Practice Recommendations for Contraceptive Use (2004) is intended for use by policy makers, program managers, and the scientific community in the preparation of national family planning/sexual and reproductive health programs for delivery of contraceptives. It provides evidence-based recommendations on how to safely and effectively use contraceptive methods once they are deemed medically appropriate for an individual.

This document provides the full list of updated HIV and infant feeding recommendations, and an explanation of key points. This information is aimed at program managers and decision makers, and those who will be in charge of revising national guidelines on the prevention of mother-to-child transmission (PMTCT) of HIV, and infant and young child feeding.  

The document provides selected practice recommendations based on the best available evidence and is intended to be used by policy-makers, programme managers, and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service delivery of contraceptives.

The objective of this adaptable tool is to assess HIV and SRH bi-directional linkages at the policy, systems and service-delivery levels. It is intended also to identify gaps, and ultimately contribute to the development of country-specific action plans to forge and strengthen these linkages. While this tool focuses primarily on the health sector it can be adapted to cover other sectors (education, social services, and labour).

This policy brief highlights why service integration makes political and program sense, and describes the lessons learned from successful integration strategies in Ethiopia, Kenya, Lesotho, and Uganda. This brief also urges policymakers and program managers to make integrated services routinely and widely available.

With increased access to antiretroviral (ARV) therapy, and the resulting improvements in health, many clients with HIV are reconsidering their reproductive options — some are deciding whether to have children, and others are resuming sexual activity while wanting to avoid pregnancy. As a result, demand for contraception among clients with HIV — especially those on ARV therapy — has increased, and new integrated options for improving access to contraception are being considered.

This framework proposes a set of key policy and programme actions to strengthen linkages between Sexual and Reproductive Health (SRH) and HIV/AIDS programmes. These linkages work in both directions, by integrating HIV/AIDS issues into ongoing SRH programmes, and conversely, SRH issues into HIV/AIDS programmes. This should enhance SRH, contribute to reversal of the AIDS epidemic and mitigate its impact.

This document explains Kenya's strategy to maximize the opportunities provided by voluntary counseling and testing (VCT) and family planning (FP) services to reach women, men, and couples with these services, using a more cost-effective and sustainable approach. The strategy's purpose is to increase and sustain the support, demand, access, and utilization of high-quality VCT and FP services offered through both the public and private sectors.