Penny drops on HIV/AIDS prevention

Providers of reproductive health services are in a strategic position to make significant contributions to closing the global HIV prevention gap, according to a new analysis published jointly by experts in the field.

Their report, published jointly by The Alan Guttmacher Institute (AGI) and the Joint United Nations Programme on AIDS (UNAIDS) with the collaboration of UNFPA (United Nations Population Fund) and the International Planned Parenthood Federation (IPPF), says more attention must be given to the benefits of integrating HIV-related activities into reproductive health services.

Reproductive health providers already offer a wide range of services to millions of women who are now at the centre of the global HIV pandemic and are increasingly expanding their outreach to adolescents and to men. Yet their current and potential role as front-line providers of HIV prevention services is largely untapped.

Entry points

Reproductive health providers are a major source of preventive health care and an important entry points for HIV prevention for millions of individuals who are at high risk of contracting the virus, including:

• Reproductive age women � who account for nearly half of adults living with HIV worldwide;
  

• young people between 15 and 24 � who account for half of all new cases of HIV and more than 13 million unwanted births each year; and
  

• expectant and new mothers�who account for 630,000 infants worldwide infected with HIV during their mother�s pregnancy, labour and delivery.

According to Heather Boonstra of AGI, "HIV is largely a sexually transmitted infection, and because reproductive health providers by definition serve people who are sexually active, we miss an opportunity if we don�t help these providers integrate HIV prevention activities into their work."

Three services

In addition to their ability to reach out to women, and increasingly to adolescents and men, reproductive health providers have the knowledge and skills upon which stepped-up interventions for HIV prevention could be built. Adequate resources are key to increasing the ability of these providers to offer three key HIV prevention services:

• HIV counselling and testing and condom promotion in a setting where many women and adolescents, in particular, are already comfortable;
  

  
  

• prevention, diagnosis and treatment of sexually transmitted infections that would otherwise increase the risk of HIV transmission; and
  

• assistance to HIV-positive women for the prevention of unwanted pregnancies, thus reducing the chances of transmission to infants.

The analysis calls for overcoming financial shortfalls and resistance to public acknowledgement of women�s and adolescents� sexuality in order to help reproductive health providers reach their full potential in closing the gap in HIV prevention through greater integration.

It also points out that integration is a two-way street: Especially with increasing numbers of HIV-positive people living longer, integrating reproductive health into HIV treatment services would help these people achieve their sexual and reproductive health goals, and would help contain the spread of HIV infection.

"Integrating HIV and other reproductive health services seems obvious, but is often not recognized at the program and policy level," said Dr. Purnima Mane, UNAIDS Director for Social Mobilization and Information.

"Policymakers and program managers need to work together to find ways to deliver these inherently inter-related services more efficiently, more effectively � and in a more coordinated manner � to address the increasing global threat of HIV to women."

Related links

A summary of The Role of Reproductive Health Providers in Preventing HIV can be found at AGI.

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