(December 2009) PRB recently published the policy brief, Supporting the Integration of Family Planning and HIV Services. This article highlights five good reasons why integration is a sound investment that will pay multiple dividends for individuals, communities, societies, and health systems.

1. International consensus has been reached on the benefits of integrating family planning and reproductive health (FP/RH) and HIV, and services and guidance are available. Since 2004, six international organizations and a number of international convocations have resolved to promote integration (see Table 1). The World Health Organization, UNAIDS, and other collaborators have published guidelines to help policymakers and program managers pursue integration in a strategic and cost-effective manner.1


Table 1
International Policy Declarations on Linking FP/RH and HIV to Meet the Objectives of Cairo and the Millennium Development Goals 2004-2009

Organization and Year Report/Policy
WHO/UNFPA, 2004 The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children.
UNFPA/UNAIDS/Family Care International, 2004 The New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health.
UNAIDS, 2005 UNAIDS strategy, Intensifying HIV Prevention, names integration an essential policy action.
United Nations General Assembly Special Session on HIV/AIDS, 2006 Declaration of Commitment to HIV/AIDS: recommends strengthening policy and programmatic linkages between sexual and reproductive health and HIV/AIDS.
African Union, 2006 Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa: recommends integration of HIV/AIDS services into sexual and reproductive health services.
WHO, 2006 Technical Consultation on the Integration of HIV Interventions into Maternal, Newborn, and Child Health Services.
Interagency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers, and Their Children, convened by UNICEF and WHO, 2007 Guidance for Global Scale-up of the Prevention of Mother-to-Child Transmission of HIV: linkages between PMTCT and sexual and reproductive health services are a key strategy.
USAID and WHO, 2009 Strategic Considerations for Strengthening the Linkages between Family Planning and HIV/AIDS Policies, Programs and Services, A Call to Action.

2. Integration leads to improved health and service delivery outcomes. A growing body of research shows that integration leads to positive outcomes on a variety of indicators. In 2009, WHO, UNFPA, IPPF, UNAIDS, and the University of California, San Francisco published a systematic review of the literature, examining the evidence on linking RH and HIV services. Of the 58 peer-reviewed studies and promising practices, 34 integrated HIV services into existing sexual and reproductive health (SRH) programs, 14 integrated SRH into existing HIV programs, and 10 integrated these two components concurrently. A majority of studies showed improvements in indicators of health as well as in overall quality of services, providing further support for fast-tracking integration.2

3. Existing HIV programs can increase access to FP services for the more than 200 million women with an unmet need for FP. This is especially true where access to HIV services has been built through programs such as the President's Emergency Plan for AIDS Relief (PEPFAR), but FP services have not similarly been expanded. In these countries, which have among the highest levels of unmet need for family planning in the world, the largest number of clients can be reached by adding FP to existing voluntary HIV counseling and testing (VCT) sites, which attract HIV-positive and HIV-negative clients. Adding contraceptive counseling to VCT sites also has the distinct advantage of serving clientele, including men and youth, who often do not use traditional FP services.

4. Family planning is a key but greatly underutilized HIV prevention strategy. The importance of FP to reducing mother-to-child transmission of HIV does not receive enough attention. Each year, more than 577,200 unintended pregnancies among HIV-infected women in sub-Saharan Africa are prevented through the use of contraception. While it is essential that all women in need of antiretroviral therapy (ART) have access to it, use of contraception already prevents a greater number of HIV infections among infants than ART.3 If the unmet need for contraception among all women in the region who did not wish to become pregnant were met, 533,000 additional unintended pregnancies to HIV-positive women could be averted each year (see Table 2).4


Table 2
Annual Number of Unintended Pregnancies and HIV Positive Births Averted by Contraception

Country Annual Number of Unintended Pregnancies to HIV-Positive Women Averted by Contraception Annual Number of Unintended HIV-Positive Births Averted by Contraception*
Botswana 13,907 4,172
Cote d'Ivoire 6,491 1,947
Ethiopia 9,092 2,728
Haiti 3,040 912
Kenya 48,631 14,589
Mozambique 61,317 18,395
Namibia 10,305 3,092
Nigeria 41,445 12,434
Rwanda 1,869 561
South Africa 400,854 120,256
Tanzania 39,917 11,975
Uganda 25,243 7,573
Vietnam 229,422 8,827
Zambia 42,745 12,823

* Authors assume a 33 percent vertical transmission rate.

Note: Data assumes no preventing of mother-to-child transmission.
Source: Heidi Reynolds et al., "Contraception to Prevent HIV-Positive Births: Current Contribution and Potential Cost Savings in PEPFAR Countries," Sexually Transmitted Infections 84, suppl. 2 (2008): 49-53.


5. Integration is cost-effective, improves access to health care, and increases financial sustainability. Integration is cost-effective for the client and the health system that is able to co-locate services. Providing family planning at HIV care treatment centers has been estimated to save almost US$25 for every US$1 dollar spent.5 At a time when there has been little progress in reducing the number of new HIV infections or in meeting the growing demand for FP, integration is a strategy to maximize scare resources and provide better service to clients.


Karin Ringheim is senior policy adviser, International Programs, at the Population Refence Bureau.


References

  1. WHO, USAID, and FHI, Strategic Considerations for Strengthening the Linkages between Family Planning and HIV/AIDS Policies, Programs, and Services, (Kampala, Uganda: FHI, 2009); and WHO, UNFPA, IPPF, UNAIDS, UCSF, Sexual and Reproductive Health and HIV Linkages: Evidence Review and Recommendations (Geneva: WHO, UNFPA, IPPF, UNAIDS, UCSF, 2009).
  2. WHO, UNFPA, IPPF, UNAIDS, and UCSF, Sexual and Reproductive Health and HIV Linkages.
  3. Heidi Reynolds et al., "The Value of Contraception to Prevent Perinatal HIV Transmission," Sexually Transmitted Diseases 33, no. 6 (2006): 350-56.
  4. Derived from: Heidi W. Reynolds, M.J. Steiner, and Willard Cates Jr., "Contraception's Proved Potential to Fight HIV," Sexually Transmitted Infections 81, no. 2 (2005): 184.
  5. John Stover, Leanne Dougherty, and Margaret Hamilton, Are Costs Savings Incurred by Offering Family Planning Services at Emergency Plan (PEPFAR) HIV/AIDS Care and Treatment Facilities? (Washington, DC: USAID, 2006).