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...coming years. Policymakers, donors, researchers and activists should recognize the benefits of supporting the fuller integration of HIV prevention efforts with reproductive health services.
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Fueled by the development of relatively effective antiretroviral therapies, providing treatment for those living with HIV and AIDS is now a major focus of global efforts to combat the pandemic. But AIDS experts warn that long-term success will require the simultaneous expansion of prevention efforts alongside care and treatment. In the absence of stepped-up prevention efforts to check the spread of the virus, treatment services will be unable to keep pace with the number of people who will need them.
To date, only a fraction of the people at risk of HIV exposure in low- and middle-income developing countries have meaningful access to basic prevention services, according to a survey conducted by the POLICY Project for the U.S. Agency for International Development (USAID) of 73 countries with more than 10,000 people living with HIV in 2003. The survey found that in these countries, only about one in 10 pregnant women had been offered HIV counseling and testing, antiretroviral therapy to prevent mother-to-child transmission or counseling on breastfeeding options. An even smaller proportion of 15-49-year-olds had had access to counseling and testing. The POLICY Project estimates that the annual need for testing is 12-14% of the general adult population in these countries, yet less than 0.2% of adults aged 15-49 were tested in 2003.
By virtue of their experience in providing a range of services--including, sometimes, HIV services--to millions of women in developing countries, reproductive health service providers could make a significant contribution in closing the gap in HIV prevention. This analysis discusses the capacity of these providers to more fully integrate HIV-related activities into their service set and the benefits that would accrue, as well as the benefits of integrating reproductive health services into HIV programs.
A Ready Infrastructure
Over the last three decades, donors and governments have invested heavily in reproductive health services, * reaching millions of women who are now at the center of the HIV pandemic. By 2003, women accounted for nearly half of all adults living with HIV worldwide--and almost six in 10 (57%) in Sub-Saharan Africa. Though reproductive health providers in developing countries largely serve married women, many of these women are at increased risk of infection by virtue of being married. Unprotected sex with a nonmonogamous husband increases a woman's likelihood of being exposed to HIV. Indeed, married women in the world's poorest countries often possess less power than do unmarried women to negotiate whether to have sex and under what conditions,...
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