The PEPFAR reauthorizing language fails to mention family planning and reproductive health, and foreign development assistance continues to be distributed in a disease-specific fashion. As HIV remains largely driven by sexual transmission, this approach is inefficient and ineffective, creating more bureaucracy and limiting services.
PEPFAR also fails to integrate culturally relevant issues regarding femininity and thef ertility aspirations of women living with HIV. Reproductive care and family planning—including access to and information about female condoms, cervical barriers, and microbicides—are essential components of HIV prevention, care, and treatment, and should be part of an expanded strategy. Sites delivering such services should be integrated into the PEPFAR program to enable women and men to access HIV services in those sites as well as those specifically designed for HIV care. To the extent possible, policy guidance should be provided to implementers to encourage and enable those serving in reproductive health service environments to provide HIV-related services.
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