Integration and Coordination: Women's Health


According to the WHO, AIDS is the leading cause of death among women aged 15-44 worldwide, and nearly 60% of those living with HIV in sub-Saharan Africa are women. As a result, it is essential that PEPFAR ensure that the services it provides for women are linked to and expand access for their primary and specialty health care needs. An ultimate goal of PEPFAR, working as part of the GHI, is to provide women and their providers with the ability to address multiple health care needs at a single visit. PEPFAR can contribute to this goal through efforts to ensure that women living with HIV have access to necessary antenatal and reproductive health care. In addition, women seeking antenatal, reproductive health, or sexually transmitted infection care should have expanded access to HIV prevention, including testing and counseling.

The WHO recommends access to a comprehensive package of services, including services for HIV, maternal and child health, sexually transmitted infections, reproductive health, and family planning. Yet in many PEPFAR countries, platforms for these services are underdeveloped or underutilized. As part of GHI, PEPFAR will focus on increasing the linkages between HIV/AIDS and reproductive health services. These linkages will offer opportunities to identify and refer women in need of HIV-related services.

PMTCT is an important focal point for the GHI effort to expand women's health services. The strength of PMTCT services is reliant upon the strength of national antenatal care programming. As part of PMTCT expansion, PEPFAR is working with countries to provide these services at existing or new sites for maternal, child, family planning, and sexually transmitted infection, and reproductive health care.

Existing family planning programs provide an excellent platform for work on HIV prevention. Women and men in these programs are already receiving information about a range of reproductive health issues. Unfortunately, in many places, family planning programs and systems are not robust and levels of unmet need for family planning are often high. In areas with high HIV prevalence and strong family planning and reproductive health services, PEPFAR has traditionally supported the provision of HIV testing and counseling within existing family planning and reproductive health sites. This co-location links women with HIV education, care, medical treatment and PMTCT as needed. Many women living with HIV, like many other women across the developing world, still experience significant unmet need for contraception. Adequate education and planning for HIV-positive women who desire future pregnancies is lacking.

As part of GHI, PEPFAR will work with countries to create comprehensive access to health services for HIV-positive women, including the following:

  • Linking commodity management efforts to create secure supply chains and ensure PEPFAR service sites have reliable sources of medications, contraceptives, and commodities;
  • Co-location of reproductive health care and HIV services;
  • Expansion of health care worker training to ensure that clinic personnel are able to provide quality reproductive health, HIV and primary care services; and
  • Integration of HIV prevention and education messaging into family planning counseling and other reproductive health discussions.

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