A Win for Women: PEPFAR Integrates AIDS and Reproductive Health

Women's health and human rights are finally being promoted and protected by PEPFAR—thanks to the efforts of activists like you.In the 2010 annual PEPFAR Country Operational Plan (COP) guidance to the field, the Obama administration urged country teams to promote greater coordination between HIV/AIDS programs and family planning and reproductive health. This is a radical departure from the Bush administration's rule that country teams could not use PEPFAR money for family planning activities—despite scientific evidence that shows integration of health services for women saves lives.It's now up to PEPFAR country teams and implementing NGOs to respond with strategies and programs to maximize family planning/reproductive health, maternal and child health and HIV/AIDS linkages.? The guidance is flexible—flexibility which is needed by country teams to create the programs that will work in their unique country context. This new PEPFAR guidance, combined with Obama's repeal of the global gag rule in January, should open the door to full integration of family planning, maternal and child health and HIV/AIDS programming—and open a whole new set of funds for holistic women's health interventions via PEPFAR.Check out the differences in language (below the cut) between the Bush Administration's COP guidance in 2009 and the Obama Administration's new 2010 language. PEPFAR used to prohibit linkages and integration for women's health and HIV programs; it now embraces them. One more win for women—thanks to your advocacy.

Bush administration FY09 COP language

• PMTCT: Provision of ARV prophylaxis and other ANC services (not to include family planning, which cannot be supported with PEPFAR resources) for HIV-infected pregnant women should be funded under PMTCT.
• Family Planning: PEPFAR funds may not be used to support family planning activities. The USG supports voluntary family planning programs largely through USAID's population and reproductive health program, while PEPFAR's mission is prevention, treatment, and care of HIV/AIDS. In any wraparounds between HIV/AIDS and family planning activities, PEPFAR funds may only be utilized to support HIV/AIDS activities.

Obama administration FY10 COP language

Maximizing Impact through Linkages and Integration with Other Programs: Supporting linkages with other health and development programs is essential to achieve not only PEPFAR-specific goals but also to address the broader health and development challenges that face our partner countries. Linking PEPFAR programs to other development initiatives provides a platform to support a comprehensive approach to HIV/AIDS affected communities and to ultimately improve their quality of life….Key areas for linking with health and development include: support to health systems strengthening, human resources for health, maternal and child health, family planning, malaria and TB, gender equality, food and nutrition, education and economic strengthening.

• Family Planning: PEPFAR is a strong supporter of linkages between HIV/AIDS and voluntary family planning and reproductive health programs. The need for family planning for HIV-positive women who desire to space or limit births is an important component of the preventive care package of services for people living with HIV/AIDS and for women accessing PMTCT services.

1. PEPFAR programs can work to expand access to FP/RH services through wraparound programming, i.e., wherever possible linking or ideally co-locating with existing FP/RH programs to ensure the availability of FP/RH information and counseling, with referral for actual services.
2. In areas with high HIV prevalence and strong voluntary family planning systems, PEPFAR programs are encouraged to support efforts to provide confidential HIV counseling and testing within family planning sites. Indeed, there is growing evidence of unmet need for these family planning services, particularly among vulnerable populations, including for women who are HIV-infected.

• Maternal and Child Health: …In keeping with priorities of the Obama Administration's Global Health Initiative, with FY 2010 funding, PEPFAR programs should focus on improving the health of these women and children by expanding integration of services to ensure a comprehensive, gender-sensitive and family-centered approach.

1. One approach country teams should consider supporting is co-location of PMTCT, MCH and family planning/reproductive health services, particularly at the primary health care level. With co-location and better integration, PEPFAR and its partners can improve both geographic access to care and availability of a package of care, including rapid HIV testing, cervical cancer screening (for women who are HIV-positive), maternal antiretroviral (ARV) treatment, and birthing facilities with integrated post-partum care for the mother and child (including family planning, early infant diagnosis, and pediatric treatment and care, such as childhood immunization).
2. Health care shortages, including midwife and nursing shortages, are well documented in most high-HIV burden countries. PEPFAR programs should support the training of health workers to deliver an enhanced package of MCH services, an essential element of improving care. Training curricula may include PMTCT services and critical MCH, family planning and reproductive health services for women living with HIV.
3. PEPFAR programs should coordinate and integrate efforts with USG-funded programs such as MCH and FP/RH programs and with international programs and their partners. Mobilizing local communities where primary health care services are delivered will help address basic issues of access, including gender inequality-based barriers, which inhibit women from seeking and using essential HIV prevention, family planning/reproductive health, and MCH services.

• Gender: PEPFAR employs a two-pronged approach: a)gender mainstreaming or integration into all prevention, care, and treatment programs, and b) programming to address five gender strategic areas:

1. Increasing gender equity in HIV/AIDS activities and services
2. Reducing violence and coercion
3. Addressing male norms and behaviors
4. Increasing women's legal rights and protection, and
5. Increasing women's access to income and productive resources

PEPFAR programs should look for opportunities to partner with and leverage with programs addressing gender norms in high prevalence HIV communities, especially in initiatives focused around education, reduction of gender-based violence, and improving women's equal participation in public and private sector activities and services.