Contraception – an effective but underutilized strategy in the fight against HIV

Contraception to prevent unintended pregnancies in HIV-positive women is an effective strategy to prevent mother-to-child transmission of HIV (PMTCT). Moreover, linkages between the family planning (FP) and HIV fields are critical to meeting the reproductive rights and needs of people living with HIV. Unfortunately, increasing access to contraception has been an underutilized strategy in the fight against HIV, despite high levels of unintended pregnancies in countries where the burden of HIV is greatest. To understand why HIV programs are falling short in making FP a central component of prevention efforts, we reviewed the international policy environment, funding trends, and country-level programs addressing FP/HIV linkages. Substantial policy support exists for stronger linkages between the FP and HIV fields. However, translating this high-level support into quality integrated service delivery programs has been hindered by several factors. First, separate funding mechanisms for FP and HIV programs has driven the vertical organization of health ministries and service facilities and undermined coordination between the two fields. Second, U.S. policies rooted in idealogical debate resulted in the proscription of contraception as part of U.S. Government-funded HIV programs. Third, PMTCT programs are limited by their focus on reaching women who are HIV-positive and already pregnant. Finally, insufficient evidence exists to endorse a set of best practices for FP/HIV service integration. More explicit support for FP by major donors and policymakers, coupled with ongoing investments in research to identify effective FP/HIV practices, is essential if contraception is to take its rightful place among HIV prevention interventions.