From effectiveness to impact: contraception as an HIV prevention intervention

Abstract

Despite substantial policy support for the integration of family planning and HIV programmes, burgeoning resources for HIV ignore the potential impact of contraception on HIV prevention. Moreover, separate funding for these two programmes and the resulting vertical organisation of health ministries and service facilities undermine coordination between departments and limit providers' ability to address the contraceptive needs of HIV-positive clients. Projects integrating family planning and HIV services are being implemented, allowing for documentation of factors that facilitate or impede integrated service delivery. However, few have been evaluated to demonstrate impact on contraceptive uptake and HIV-positive births averted.

HIV in adolescents in sub-Saharan Africa

“…For example, contraception is widely available in much of Africa, but in many countries is primarily promoted to married women after the birth of their first baby and is not easily accessed by adolescent girls. Given the particularly high prevalence of HIV among young antenatal clinic attenders (aged [15][16][17][18][19], promotion of contraception to sexually active nulliparous adolescents is likely to be an effective means of preventing mother to child transmission (MTCT) [23].…”

Reproductive choices for women with HIV

“…Separate funding streams further hinder opportunities for linkages in recipient countries by cultivating parallel reproductive health and HIV/AIDS departments within ministries of health, which in turn create vertically oriented policies, strategies, training programmes and, ultimately, service delivery systems. 16 …”

How should we care for patients who are not yet eligible for ART?

“…Proven HIV prevention interventions to be included in pre-ART care include treatment for sexually transmitted infections after symptom screening by lay counsellors, 22 condom promotion and distribution, 23 contraception 24 and pregnancy planning services. 25 Initiating ART at CD4 counts >350 cells/µl for patients in serodiscordant couples is a highly effective prevention strategy 26 that could be implemented more easily if patients were retained in active pre-ART care.…”