The President's Emergency Plan for AIDS Relief has helped avert 150,000 infant HIV infections, thanks to antiretroviral (ARV) treatment. But despite PEPFAR's significant progress, just one in 10 HIV-positive women in Africa has access to ARVs, say some health activists. A more effective way to prevent mother-to-child HIV transmission, they say, is to prevent unintended pregnancies among these women by improving access to birth control.
"The immediate concern is that PEPFAR is not supporting access to [a wide variety of] contraceptives," said policy analyst Katie Porter of Washington, D.C.-based Population Action International (PAI). "While they support condom use, which is important, they are not providing other contraceptive commodities to women in what would be a very appropriate setting."
"If you can intervene when women come in for these services and offer them contraceptives, you help to reduce unintended pregnancies among HIV-positive women, and that would further enhance these programs," said Porter.
Just a small portion of PEPFAR's annual spending is earmarked for family planning and reproductive health, said Porter. And, "If you look at PEPFAR's 15 focus countries, where efforts to address the needs of women and girls and to address HIV prevention [are] paramount, we are seeing a decrease or flat-lining of funding for international family planning [in 10 of the countries]," she said.
According to PAI, four of the 15 countries receive no family planning assistance. The other 11 nations, all of which have high fertility rates and an unmet need for contraception, receive some birth control aid, though only Rwanda got a small increase.
The US Agency for International Development handles the bulk of family planning services, spending an average of $440 million over the past five years. Dr. Thomas Kenyon, principal deputy AIDS coordinator and chief medical officer for PEPFAR, said USAID coordinates with PEPFAR to ensure appropriate linkages between the programs' distinct focuses.
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