HIV is a sexual and reproductive health issue, both because sexual transmission is the greatest cause of new infections, and because women living with HIV have urgent reproductive health needs, including the need to avoid unwanted pregnancy or prevent HIV transmission to any children they wish to bear. By failing to require strong linkages among maternal health, family planning and HIV interventions, PEPFAR has missed countless opportunities to improve the health and save lives.
 
U.S. global AIDS policy should promote full integration of HIV/AIDS and sexual and reproductive health services. User-based integration of these services is paramount because:

• Integration addresses the needs of women and girls who are at high risk of both HIV infection and unwanted pregnancy.

• Bringing related services together under one roof reduces the burden for those seeking care, greatly increasing the likelihood that they will get the care they need.

• Where co-location of services is impractical, designing seamless referral systems ensures that users find appropriate care with minimal effort and cost.

• Integrating services can reduce costs for governments and donors by avoiding duplication of infrastructure and overhead.

• Thinking about people as whole human beings who have a range of sexual and reproductive health needs just makes sense.

Until recently, despite recommendations from the World Health Organization (WHO), U.S.-funded operational research, and even the Office of the Global AIDS Coordinator (OGAC),  decision makers have not fully recognized the importance of strengthening and linking health services that provide multiple benefits – including sexual and reproductive health services and HIV prevention.

However, the U.S. government is beginning to shift toward an integrated approach.  The Obama administration’s Global Health Initiative frames a robust HIV/AIDS response within the larger global health context, promising an approach that integrates HIV/AIDS within sexual and reproductive health.  Moreover, on December 1, 2009, Ambassador Goosby released PEPFAR’s five-year strategy, which indicated that a key goal is to expand integration of HIV prevention, care, support, and treatment services with family planning and other reproductive health services.  CHANGE is encouraged by these developments and will continue to monitor implementation to ensure that it meets the needs and protects the rights of women and girls.