Last month, the President's Emergency Plan for AIDS Relief (PEPFAR), in partnership with George W. Bush Institute, Susan G. Komen for the Cure, and UNAIDS, launched the global "Pink Ribbon Red Ribbon" campaign, an initiative that integrates cervical and breast cancer education, screening, and treatment with HIV services. It's a move that has the potential to reduce the number of cancer deaths among women living with HIV and improve their overall health. Given that women living with HIV are at an increased risk of developing cervical cancer, it makes sense. It's a logical and critical part of what PEPFAR is calling care and support services.
What doesn't make sense is that planning a family and preventing further HIV transmission is not part of what PEPFAR is calling care and support. HIV was responsible for 60,000 maternal deaths in 2008, and pregnancy alone could put women at higher risk of transmitting and acquiring HIV. Integrating and linking voluntary family planning, HIV, and cervical cancer prevention saves lives, improves access to quality care and promotes human rights. Including family planning in Pink Ribbon Red Ribbon would help women manage childbearing and protect themselves and their partners from infection or re-infection (think female condoms) and should be automatic.
UNAIDS has stated as much. "We must take AIDS out of isolation and provide young girls with opportunities to negotiate their sexual relationships and receive sexuality education so that they can protect themselves from infection," said UNAIDS Executive Director Michel Sidibé at this year's Commission on the Status of Women. "If we don't do this, our vision of zero new infections will remain a dream."
Furthermore, in June 2011 at the United Nations General Assembly High Level Meeting on HIV/AIDS, member governments -- including the U.S. -- pledged to increase the capacity of women and adolescent girls to protect themselves from the risk of HIV infection through access to sexual and reproductive health programs and services. They also committed to strengthen the link between HIV services and sexual and reproductive health care, and eliminate the redundant systems that come about when programs are not integrated.
So what doesn't make sense now is that the U.S. government and UNAIDS are supporting a sexual and reproductive health program that intentionally excludes family planning.
It's counter-intuitive and counter-productive.
U.S. foreign policy, through the Global Health Initiative and starting with PEPFAR, needs to integrate family planning; maternal health; and HIV prevention, treatment, and care services on the ground. Pink Ribbon Red Ribbon is a stellar example of how integrating a range of sexual and reproductive health services has the potential to save so many lives -- and evidence points to integrating family planning as well.
We cannot pick and choose to address only the health issues we are comfortable addressing. We must develop and implement services and programs that are based on the health needs and human rights of clients, not what is politically expedient for policy makers or convenient to service providers. Women deserve the highest quality sexual and reproductive health services available: HIV prevention, treatment, and care; cancer screening and treatment; maternal health care; and family planning services. When the U.S. government starts integrating sexual and reproductive health interventions, it cannot be piecemeal--the full range of reproductive health matters must be addressed.
Access to such services is not only a right. It's the best thing for everyone.
To read further about U.S. foreign policy and integrating sexual and reproductive health and rights, see the Center for Health and Gender Equity (CHANGE)'s policy brief "The U.S. Global Health Initiative and Sexual and Reproductive Rights: Integration".