Mother and children during a home case management visit, through the KIZAZI KIPYA (New Generation) project in Tanzania.
Photo Credit: KIZAZI KIPYA (New Generation) project, Photographer: Michael Goima/Pact (2020)
Choosing the number, timing, and spacing of children is a basic right of all women and couples, no matter their HIV status. Every person also has the right to quality, voluntary contraceptive services. More than 218 million women globally have an unmet need for family planning, meaning they want to delay or avoid pregnancy but are not using a modern method of contraception. Approximately one in four women of reproductive age in sub-Saharan Africa have an unmet need for family planning, and women living with HIV have even more limited access to contraception and reproductive health care than the general population. Many women, especially adolescent girls and young women, are simultaneously at risk for both unintended pregnancy and sexually transmitted infections, including HIV.
Ensuring all women, men, and youth living with HIV have access to sexual and reproductive health services can significantly reduce unplanned pregnancies, maternal deaths (including those related to HIV), and new pediatric HIV infections. Family planning is vital to safe motherhood, healthy families, and prosperous communities. Providing integrated family planning and HIV services is also crucial for meeting the world’s Sustainable Development Goals, achieving the collective vision for family planning under the new Family Planning 2030 (FP2030) Initiative, and realizing USAID’s global health goal of an AIDS-free generation. USAID works to increase access to family planning information and use of voluntary contraceptive services for all who want it. However, specific considerations must be addressed to ensure comprehensive care for people living with or affected by HIV.
Under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), USAID’s Office of HIV/AIDS and Office of Population and Reproductive Health strategically lead the technical and programmatic integration of HIV and family planning activities to advance our commitments to the achievement of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 goals and the global vision and goals of the FP2030 Initiative. Integrated programs and services leverage limited financial and human resources by meeting multiple health needs and increasing access to quality comprehensive care for the vulnerable populations USAID serves. Opportunities for strategic integration of family planning exist across HIV prevention, care, and treatment platforms. The U.S. Government’s global health strategy to meet the contraceptive needs of people living with HIV is based on three key guiding principles:
- A focus on reproductive rights through voluntarism and informed choice
- Quality service provision through evidence-based programming
- Development of partnerships at the global, country, and local levels.
Integrated services can ensure that all people living with HIV have access to family planning services that support their fertility desires and choices. Supporting context-specific models of integration (as there is no “one size fits all” approach to family planning and HIV integration) is a key pillar of USAID’s approach to meeting the holistic needs of the clients we serve. PEPFAR funds cannot be used to procure contraceptive commodities except for male and female condoms. Therefore, it is critical that USAID Missions, in partnership with national governments, provide technical leadership and support to ensure that a wide range of contraceptive commodities are available in USAID-supported health sites, including HIV service delivery sites where family planning method provision is a part of the service delivery package.
In addition, USAID, in collaboration with PEPFAR partners, is actively engaged in analyzing and interpreting available data on key opportunities and issues such as the integration of prevention methods (e.g., pre-exposure prophylaxis [PrEP]) with family planning services, hormonal contraception-antiretroviral therapy (ART) interactions, and access to comprehensive sexual and reproductive health services for adolescent girls and young women. USAID also supports the development of innovative multi-purpose contraceptive technologies to protect against unintended pregnancy, HIV, and other sexually transmitted infections.
Mother and child during a family planning visit, at a DREAMS/Zambia Community HIV Prevention Project (Z-CHPP) center in Lusaka.
Photo Credit: USAID Pact/DREAMS Z-CHPP project, Photographer: Brian J. Clark/Pact (2020)
USAID’s family planning and HIV integration efforts have led to achievements in the following areas:
- Supported the provision of voluntary integrated family planning services in PEPFAR-supported sites across more than 30 countries
- Supported research studies, developed technical briefs, developed program implementation tools, and provided technical assistance to national programs to scale up evidence-based integration models
- Identified and supported opportunities for integrating the provision of contraceptives through multi-month dispensing and decentralized service delivery platforms for women living with HIV
- Implemented the delivery of PrEP in family planning settings to expand reach of this critical HIV prevention method to women, men, and youth
- Facilitated an enabling environment for family planning and HIV integration, including support for the creation of technical working groups to develop and disseminate national policies and implementation guidance related to integration
- Identified critical system barriers and constraints to integrating family planning and HIV service delivery and designed programs to address them
- Provided technical support for family planning service delivery and commodity security in line with identified needs and worked collaboratively with other donors to meet those needs
- Ensured linkages between family planning and HIV prevention, care, and treatment programming, including those related to prevention of vertical transmission, care and treatment, key populations, condoms, PrEP, adolescent girls and young women through the DREAMS partnership, and gender and gender-based violence.
Voluntarism and Informed Choice:
USAID supports a woman’s right to use or not use family planning regardless of HIV status. Her decision should be free of any discrimination, stigma, coercion, duress, or deceit and informed by accurate, comprehensive information and services, including access to a wide range of contraceptive methods. In addition, the provision of health care, including ART, should never be conditioned on acceptance of a family planning method. Learn more about USAID’s family planning guiding principles and U.S. legislative and policy requirements.
- Connecting the Dots on the Impact of COVID-19 on FP
- Family Planning/HIV Integration: Important Contributions to the Global HIV Goals
- Toolkit on Integration of Family Planning and HIV Services
- Family Planning and HIV Service Integration eLearning Course (available in Arabic, English, French, Portuguese, and Spanish)
- Integrating Family Planning into HIV Programs: Evidence-based Practices
- Sexual and Reproductive Health and HIV Linkages Toolkit
- Contraception for Female Sex Workers
- Resources for Providing Oral PrEP in Family Planning Settings
Family Planning/HIV Programming Guidance:
- Leveraging Differentiated ART Delivery Models to Strengthen Family Planning Care: A Supplement to A Decision Framework for Antiretroviral Therapy Delivery
- Family Planning: A Global Handbook for Providers 2022 Edition
- World Health Organization Contraception Overview
- Field Guide: Family Planning and HIV Integrated Supply Chains
- WHO Department of Reproductive Health: Medical Eligibility Criteria for Contraceptive Use
- WHO Contraceptive Eligibility for Women at High Risk of HIV Guidance Statement
- PEPFAR Family Planning/HIV Task Force commentary: Meeting the Family Planning Needs of Women Living with HIV in U.S. Government Global Health Programs
U.S. Government Technical Briefs:
- U.S. Government Contraception for Women at High Risk of HIV Technical Update Briefer
- Issue Brief: Decreased Contraceptive Efficacy Reported in Women Living with HIV Who Use Implants While Taking the Antiretroviral Efavirenz
- Issue Brief: Drug Interactions between Hormonal Contraceptive Methods and Antiretroviral Medications Used to Treat HIV
Monitoring and Evaluation:
- Family Planning/HIV Integration Quality Assurance Tool
- Family Planning and HIV Indicators Database
- Monitoring the Integration of Family Planning and HIV Services: Indicators both to Measure Progress toward the 90-90-90 Targets and Ensure the Reproductive Rights of All Women
- Adolescent and Youth Sexual and Reproductive Health Indicators Database