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To the Next US Secretary of State

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This post is co-authored by Pamela W. Barnes, president and CEO of Engenderhealth. Ms. Barnes has more than 30 years experience in global health. Prior to joining Engenderhealth, she served as president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation.

To the next U.S. Secretary of State:

Congratulations on your appointment. You have some big shoes to fill.

Hillary Clinton has been a firm diplomat -- and a tireless champion of global health and women's rights.

On Thursday, the eve of World AIDS Day, she released a blueprint for creating an AIDS-free generation.

As a part of an expansive vision, the blueprint called for integrating family planning services and HIV prevention and treatment programs -- a linchpin for empowering women, including women living with HIV, to make their own choices about whether to have children, when to have them, and how many to have.

The story of Maimuna, a 28-year-old Tanzanian woman, illustrates why this matters. She learned that she carried HIV during a prenatal care visit to the Magugu Health Center.

If she hadn't visited the Center, she might never have had an HIV test while pregnant. Her baby might have been born with HIV. She may have remained untreated herself.

But the Center's staff, experts in both prenatal and HIV care, provided anti-retroviral treatment that allowed Maimuna to birth a healthy child. She stayed healthy, too.

Staff at Magugu also counseled her and her husband, Jumanne, in family planning - the most effective tool for preventing both mother-to-child HIV transmission and reducing maternal mortality.

"We don't plan to have any more children because now we are fighting for our own lives," said Jumanne, who is also living with HIV. "I am grateful that we don't have to travel to many different places to get all of the care we need."

Unfortunately, the integrated services at the Magugu Health Center are still uncommon, particularly in the communities hardest hit by HIV. This deprives health care workers of a crucial tool in stopping the virus, and ignores the great demand of women to safeguard their health and that of their families.

Women of childbearing age account for roughly half of the 40 million people living with HIV. Across sub-Saharan Africa, young women between the ages of 15 and 24 account for 75 percent of new HIV infections.

With proper care, these women have an excellent chance to space childbirth or delay pregnancy, or have a healthy pregnancy and birth if they choose. On the other hand, women without access to quality reproductive health care still face a substantial risk of dying during childbirth in many parts of the world, especially those most ravaged by AIDS. Given these realities, the integration of family planning, maternal health, and HIV prevention and treatment is a matter of common sense.

And it is a crucial element in helping realize Sec. Clinton's goal of achieving an AIDS-free generation.

Integrated services reduce inefficiencies and costs while better serving millions of women. Secretary Clinton's blueprint will call for greater coordination among international donors, governments, and the U.S. agencies tasked with fighting the AIDS epidemic -- the Centers for Disease Control, the Agency for International Development, and others active under the President's Emergency Plan for AIDS Relief, or PEPFAR.

The blueprint will call on them to jointly promote the integration of family planning and HIV services around the world.

As the nation's next Secretary of State, you will play a crucial role in making sure the blueprint is translated into action. For all its laudable goals, the plan will amount to nothing if it is left to collect dust in Foggy Bottom.

This will require close coordination with governments, communities and health care providers funded through PEPFAR, which has spent hundreds of millions of dollars to make HIV treatment, care, and prevention more accessible around the globe.

Promoting the integration of family planning and HIV services will help safeguard the massive investment that PEPFAR has made to prevent the spread of the virus and improve the lives of those living with it.

As Maimuna can attest, all women -- including those living with HIV -- must be empowered to make their own decisions about the timing and spacing of their children. Those who wish to prevent pregnancy must have access to an array of contraceptive choices -- not only the male and female condoms that are critical to preventing HIV transmission, but the many other methods critical to preventing pregnancy.

Such services must be provided in a manner that respects women's rights, including the provision of information and counseling services that are free of coercion, judgment and discrimination.

This is a vision that Secretary Clinton worked hard to promote. We hope you will make this vision a reality.

Additional resources:
Family Planning-Integrated HIV Services: A Framework for Integrating Family Planning and Antiretroviral Therapy Services (Engenderhealth)
U.S. Global HIV Policy: Combination Prevention (CHANGE)