Washington Memo
December 07, 2012

New PEPFAR Blueprint: Civil Society Essential to Achieving AIDS-Free Generation

Last week the U.S. government released the PEPFAR Blueprint: Creating an AIDS-Free Generation, which puts forward a bold vision to save lives and achieve an AIDS-free generation.  It provides an important framework for delivering integrated family planning and HIV/AIDS services and ensuring that civil society voices are represented in this global effort.

In order for the U.S. government to deliver on this ambitious vision, it is important that the following aspects of the blueprint are fully implemented.

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Commitment to Family Planning/Reproductive Health and HIV/AIDS Integration

There is clear support for an integrated approach to HIV/AIDS and FP/RH services.  The blueprint endorses the provision of care at “a single one-stop location” (18).  Access to voluntary family planning and reproductive health information and services is identified as a key component of PEPFAR’s approach to preventing mother-to-child transmission (16-19), promoting gender equality (33), and providing comprehensive prevention services for people living with HIV (32).  In order to further support this work, the blueprint commits PEPFAR support to the development and dissemination of technical guidance on family planning and HIV (35).

PEPFAR also announced they will develop “National Condom Strategies” in conjunction with partner governments (24).  Male and female condoms are effective HIV prevention tools and provide the dual benefit of preventing unintended pregnancies.  These strategies create the opportunity to improve procurement, forecasting and distributions systems that could increase the availability of condoms, in addition to other HIV and family planning commodities, which face similar logistics issues.  These strategies should incorporate  contraceptive methods beyond condoms because, as the blueprint rightly recognizes, girls and young women often cannot negotiate condom use (39).  Contraceptive stock outs and the use of separate funding streams are ongoing barriers to the delivery of integrated HIV and family planning care.


As part of our effort to go where the virus is, we are focusing even more intently on women and girls, because they are still at higher risk then men of acquiring HIV because of gender inequity and violence. So we are working to ensure that HIV/AIDS programs recognize the particular needs of women and girls, for example, by integrating these efforts with family planning and reproductive health services--Secretary Hillary Clinton, November 29th 2012


Engagement of Civil Society

The blueprint reaffirms PEPFAR’s commitment to supporting country-led and implemented responses to HIV/AIDS.  It also details efforts to measure process towards this “country ownership” principle through the development of a “scorecard” (44-45).  The engagement of and support for civil society and people living with HIV is emphasized in this document.  Civil society is cited as a key actor in ensuring that HIV/AIDS programs meet the needs of women and children (18) and are delivered effectively at the community level (36).  Importantly, civil society’s role in mobilizing political will through advocacy is also recognized. PEPFAR commits to supporting civil society’s efforts to provide HIV services and expand their advocacy capacity through the Local Capacity Initiative (45-46).

The blueprint also announces a significant change in PEPFAR’s Country Operational Plan (COP) process in order to demonstrate its commitment to civil society engagement.  U.S. mission teams will now be required to outline how civil society engagement will be part of their process to develop the COP (46).  These documents will be made public, providing an opportunity for increased accountability.  This is a welcome change to a process that in many countries has not been transparent or open to contributions from civil society stakeholders.  The inclusion of civil society in the COP process provides an opportunity to articulate the community demand for integrated FP-HIV services and address remaining barriers. These include PEPFAR’s decision not to let country teams use PEPFAR funds for contraceptives beyond condoms, where needed to achieve HIV/AIDS goals.

Lessons Learned

The blueprint highlights PEPFAR’s successful efforts to scale up and document other integrated services, like TB and HIV, which have increased by more than 800% in the past five years (27).  Sharing best practices and lessons learned from this work would be beneficial as country teams and implementers pursue integration of other health services, including family planning, reproductive health, HIV/AIDS and maternal, newborn and child health.   As PEPFAR continues to pursue the most impactful and efficient approaches, it is important to document FP-HIV integration. This would help measure outcomes associated with this new approach and  ensure that funding is made available to implement integrated service delivery.

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It is clear that FP-HIV integration and civil society engagement is essential to achieving PEPFAR’s goal of creating an AIDS-free generation.  Civil society should take advantage of this new framework and the opportunities it affords.  Implementing this vision would be a significant contribution toward meeting the comprehensive health needs of women and girls worldwide and hopefully tip the scales to address the remaining barriers to efficient, integrated FP-HIV service delivery.

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