Reproductive choices for women with HIV.

Reproductive choices for women with HIV.

Access to reproductive health services for women with HIV is critical to ensuring their reproductive needs are addressed and their reproductive rights are protected. In addition, preventing unintended pregnancies in women with HIV is an essential component of a comprehensive prevention of mother-to-child transmission (PMTCT) programme. As a result, a call for stronger linkages between sexual and reproductive health and HIV policies, programmes and services has been issued by several international organizations. However, implementers of PMTCT and other HIV programmes have been constrained in translating these goals into practice. The obstacles include: (i) the narrow focus of current PMTCT programmes on treating HIV-positive women who are already pregnant; (ii) separate, parallel funding mechanisms for sexual and reproductive health and HIV programmes; (iii) political resistance from major HIV funders and policy-makers to include sexual and reproductive health as an important HIV programme component; and (iv) gaps in the evidence base regarding effective approaches for integrating sexual and reproductive health and HIV services. However, we now have a new opportunity to address these essential linkages. More supportive political views in the United States of America and the emergence of health systems strengthening as a priority global health initiative provide important springboards for advancing the agenda on linkages between sexual and reproductive health and HIV. By tapping into these platforms for advocating and by continuing to invest in research to identify integrated service delivery best practices, we have an opportunity to strengthen ties between the two synergistic fields.

This ‘must read’ article cogently lays out the human rights and public health arguments for effective linkages and integration of HIV services with sexual and reproductive services। If you have not been convinced that contraceptive use should be an indicator of programmatic success for vertical transmission prevention programmes, you may think twice after reading this article about measuring only the ‘cascade’ which starts with the proportion of women accessing antenatal care services. Women living with HIV need sexual and reproductive health services when they do not wish to become pregnant, when they wish to become pregnant, when they are pregnant and wish to continue their pregnancy, and when they are pregnant and do not wish to continue their pregnancy. As the Convention on the Elimination of all Forms of Discrimination Against Women states: all women have the right ‘to decide freely and responsibly on the number and spacing of their children and to have access to the information, education, and means to enable them to exercise these rights’. A new wind is blowing and it is high time to make both vertical and integrated sexual and reproductive health services priority strategies as we aim to eliminate mother-to-child HIV transmission.