No woman can really say she looks forward to her annual visit to the gyno. But imagine if that visit included waking up before sunrise, walking to a bus stop an hour away, riding the bus for a few hours, or simply walking for hours just to reach your doctor’s office. Once you get there, you are given two options: meet with someone about contraceptive services or HIV/AIDS testing and medications—but not both.
What would you choose? Would you even be motivated to go? This is the reality many women in developing countries face because of funding decisions made by policymakers in Washington, D.C.
When President Bush created the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, family planning services or supplies (other than condoms) were excluded from receiving any PEPFAR funding. That makes it harder for clinics to offer both HIV and family planning services, since there can be confusion over what can be purchased. Under the Obama administration, there has been a push to allow clinics to provide integrated services, but PEPFAR still cannot directly purchase the majority of contraceptives.
In sub-Saharan Africa, more than 22 million people are living with HIV; 60 percent are women. And 53 million women in the region want to prevent pregnancy but lack modern contraception. These women want what we all do: to protect their own health, and keep their partners and families healthy as well. But too often, they are forced to choose one life-saving service over another, or spend their entire day trekking from one clinic to another to access all the health services they need.
Not every health clinic in the U.S. is a picture of perfection, but most of us have the option to get essential reproductive health exams, access family planning services, and check our HIV status in one setting. Comprehensive care should be the norm for all.
The good news is that PEPFAR is working on pilot integration programs in five countries, and has also created an integration task force to meet with HIV/AIDS advocates from a number of organizations. Organizations like the World Health Organization (WHO), UNAIDS, and agencies like USAID are also working to provide evidence on the benefits of integrated services. But many women, especially HIV-positive women, often face stigma for requesting contraceptives or assistance to make sure future children are born HIV-free.
Today is National HIV Testing Day, when many U.S. health providers will offer free HIV testing at convenient locations. This same spirit of convenience is needed for integrating family planning and reproductive health with HIV/AIDS services at the global level. When a woman can address all of her reproductive needs in one place, her health, her children’s health, and partner’s health can benefit.
Let’s ensure that U.S. policies not only promote regular HIV testing, but integrated care as well.