© 2007

Meeting the Dual Challenge: Integrating Family Planning and HIV Prevention Integrating Family Planning and HIV Prevention Rehana Ahmed, MD Reproductive Health Specialist, The MDG Centre and Board Member, PSI 16 October 2007

© 2007 What is Integration? Offering two or more services at the same facility Encouraging clients to use the other services during the same visit Example: HIV Prevention with Family Planning (FP) or Maternal and Neonatal Health (MNH)

© million couples have an unmet need for modern contraception 80 million women have unintended pregnancies 45 million pregnancies end in abortion 500,000 women die yearly from pregnancy-related causes Unmet Need for Family Planning Source: The Lancet

© 2007 HIV prevention and FP needs intersect for the same population of sexually active individuals FP is a key strategy for Prevention of Mother to Child Transmission (PMCT) of HIV worldwide Counseling and Testing attracts a range of clients including men, youth and sex workers who may not visit FP clinics …… no missed opportunities Integration is cost effective, saving on ARV prophylaxis and treatment Integrate HIV Prevention with Family Planning OPTION A HIV & FP

© 2007 Contraceptive use in 2006 averted the births of over one million infants who would have been infected with HIV 1,603, , , , , ,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 Without Any Contraceptive Use With Current Contraceptive Use Number of Infants Born With HIV 1,073,000 Fewer Cases Source: Population Reports, Johns Hopkins Bloomberg School of Public Health Family Planning is a Key Strategy to Reduce Mother-to-Child Transmission OPTION A HIV & FP

© 2007 Integration of FP in HIV Prevention programs and vice versa increases access for young sexually active men and women; sex workers Prevention of Mother to Child Transmission provide an opportunity for linkage with FP services as those targeted have FP needs Funding for HIV Prevention programs has increased over the last decade but straight–lined or declined for FP Increased Access to Family Planning and HIV Prevention OPTION A HIV & FP

© 2007 PSI / Cambodia OPTION A HIV & FP

© 2007 PSI / Cambodia PSI’s Sun Quality Health franchise providers are trained to integrate HIV counseling / services and referral into existing family planning services OPTION A HIV & FP

© 2007 PSI / Madagascar Synergy of HIV prevention and FP services helps to meet the unique needs of adolescents whose behavior typically puts them at risk for both unintended pregnancies and HIV 75,000 clients at 150 clinics reached so far this year, with strong evidence of increases in condom use, abstinence, and partner reduction among clients There is a Youthquake in Developing Countries OPTION A HIV & FP

© 2007 Integrate HIV Prevention with Maternal and Neonatal Health (MNH) OPTION B HIV & MNH Opportunity to offer MNH services beyond family planning PMCT services are begun in association with antenatal care services Integration is cost effective and leads to health impact

© 2007 Integrate What Makes Sense OPTION B HIV & MNH Postnatal Care Antenatal Care Family Planning HIV Counseling PMCT

© 2007 U.S. funding for family planning has declined in inflation-adjusted dollars by 39 percent since 1995 Global spending on family planning and other global health priorities has not increased commensurate with HIV/AIDS expenditures Most developing countries are not in a position to provide substantial funding for population activities Family Planning Underfunded, Despite Ongoing Need Sources include: Global Health Council

© 2007 International Translate Policy into Budgetary Reality Proposals to Donor must include Integration Plan Strategic Advocacy National Ministry of Health Structures and Processes FP and HIV Country Strategies Service Provision Guidelines Technical Support & Training Community Level Education Enabling Factors for Integration

© 2007 More mothers, children and fathers protected from HIV infection More mothers enjoy birth spacing, healthier mothers and children Achieve desired family size Superior cost-efficiency and cost effectiveness for recipient governments and donors Utility and Benefits of Integration

© 2007 OPTION A HIV & FP HIV FP? MNH? OPTION B HIV & MNH Two Peas in a Prevention Pod

© 2007 The value of contraception to prevent perinatal HIV transmission. Reynolds HW, Janowitz B, Homan R, Johnson L. Health Services Research Division, Family Health International, Research Triangle Park, North Carolina “Population Reports,” Johns Hopkins Bloomberg School of Public Health, “Women and HIV: Questions Answered,” Info Reports, Johns Hopkins Bloomberg School of Public Health, “Family Planning and HIV Prevention: Creating Synergies,” PSI Issue Brief, 2007 ( “Meeting the Sexual and Reproductive Health Needs of People Living With HIV,” Guttmacher Institute policy brief, 2006 ( “The Role of Reproductive Health Providers in Preventing HIV,” Issues in Brief, Guttmacher Institute/UNAIDS, 2004 ( Suggested Reading

© 2007