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Preventing HIV/AIDS
Since a majority of HIV transmission takes place
through sexual contact, reproductive and sexual
health information and services provide a critically
important entry point to HIV/AIDS prevention. They
also provide a conduit to and delivery point for programmes
of care and treatment.
Reproductive health services can help prevent
HIV transmission by: providing education on risks to
influence sexual behaviour; detecting and managing
sexually transmitted infections (STIs); promoting the
correct and consistent use of condoms; and helping to
prevent mother-to-child transmission.(10) Linking HIV
prevention and the prevention and treatment of STIs
with family planning and maternal health interventions
can improve outreach, reduce stigma and save
money by using existing resources and infrastructure.
A number of initiatives, primarily in Africa,
have sought to link HIV prevention and reproductive
health programmes.(11) But in many settings, the two
programmes are not linked to each other.
CALL TO COMMITMENT. In June 2004, UNFPA,
UNAIDS and Family Care International convened a
high-level global consultation, involving health ministers,
parliamentarians, ambassadors, leaders of UN
agencies, donor organizations, community and NGO
leaders, young people and people living with HIV.
The meeting resulted in a Call to Commitment that
emphasized “the urgent need for much stronger
links between sexual and reproductive health and
HIV/AIDS policies, programmes and services”.
Closer links—including provision of reproductive
health information and services to all people reached
by HIV/AIDS programmes, and of HIV/AIDS information
and services to all people reached by reproductive
health programmes—are critical to success in both
areas and to achieving the MDGs, the call stated, and
“will result in more relevant and cost-effective programmes
with greater impact”.
EDUCATION ON RISKS. Up to now, few family planning
programmes have focused on enabling providers
to deal with sexuality issues. A recent study in the
United Republic of Tanzania, for example, found that HIV/AIDS was mentioned to family planning clients
only briefly during counselling for informed choice,
when “women were told that condoms prevent STIs
such as HIV, and other methods do not”.(12)
The International Planned Parenthood Federation
has trained a number of family planning associations
on sexuality, gender and quality of care.(13) These experiences
have shown that counselling on sexuality can
take place if providers have adequate training. In
studies in Kenya and Zambia, however, most providers
said they doubted their ability to adequately counsel
clients on contraceptive needs in light of HIV.(14)
Programmes need to train all providers to help
clients assess HIV risk and counsel them about avoiding
both disease and unintended pregnancy. Training must
also include correct information on contraceptive methods
to help dispel the myths and rumours that abound.
MANAGING STIs. The presence of one or more STIs
significantly increases the risk of becoming infected
with HIV. A recent U.S. study found that treating
an STI in an HIV-infected person can result in a 27 per cent reduction in HIV transmission, without
any other behaviour change.(15) A study in the United
Republic of Tanzania in the mid-1990s showed that
preventing and treating STIs could prevent about
40 per cent of new HIV infections.(16) The study also
showed that community-based publicity, partner
notification and treatment efforts could reduce
the spread of STIs.
Reproductive health programmes can educate
service users about STIs, their symptoms and transmission,
and healthy behaviour. Detecting and
managing STIs has proven difficult, however. Most
women with STIs have no symptoms, and as a result,
efforts to identify and treat them in reproductive
health settings have proven to be of little benefit for
women.(17) Consequently, STIs have not received adequate
attention in either reproductive health or HIV
programmes,(18) and health ministries have done little
to ensure that they are included.(19) The recent development
of cheaper tests for common STIs could help
remedy this deficiency.
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