Hitched: Family Planning and the Elimination of Pediatric AIDS

"When we try to pick out anything by itself, we find it hitched to everything else in the Universe."  – John Muir

The goals that the international community has set around the elimination of pediatric AIDS are appropriately high. During the past decade, HIV professionals have developed effective tools to combat mother-to-child HIV transmission, including the scale-up of HIV screening in antenatal care services and provision of more effective prophylactic regimens. Despite these advances, we cannot ignore the inextricable link between HIV and other health outcomes. 

To achieve sweeping changes for the health and well-being of the world’s children, and in particular to end AIDS in children, we must look across multiple disciplines.

One of the most critical areas to address is also one of the most challenging to promote, because it happens long before there is a child in a mother’s arms. For us to reach the important goal of pediatric AIDS elimination, we must ensure that women and couples have access to family planning services, so that they can freely choose the timing and spacing of their children.

Currently, 222 million women want to delay or avoid pregnancy, but are not using a modern method of contraception. Serving women in developing countries with an unmet need for voluntary contraception would prevent 54 million unintended pregnancies, 26 million abortions (of which 16 million would be unsafe), 7 million miscarriages, 79,000 maternal deaths, and 1.1 million infant deaths every single year.    

USAID’s family planning programming supports a person’s right to determine—as a matter of principle—the number, timing, and spacing of their children, as well as use of voluntary family planning methods, regardless of a woman’s HIV status. 

However, specific considerations must be addressed to ensure comprehensive care for people living with or affected by HIV.

We must coordinate our work to ensure women living with HIV have the ability to delay pregnancies for better birth spacing, so that she can best care for herself and her child and, during pregnancy and postpartum, is able to utilize the most effective HIV prophylaxis available.

For women who don’t want any more children, we must ensure that voluntary, long-term and permanent methods are available, as they should be for all women. Reducing the number of unintended pregnancies reduces the number of infants exposed to HIV, and consequently, the number of babies potentially infected with HIV.

Unfortunately, some studies indicate that women living with HIV continue to face stigma and other barriers when seeking family planning services. Women living with HIV are often not given the same choices as other individuals. Misinformation about the use of contraceptives and the fertility of HIV-positive women is frequently reported. 

It is imperative that all HIV-positive people receive accurate, comprehensive information and access to a variety of family planning methods, not just condoms. USAID’s family planning and reproductive health programs prioritize “smart” integration practices—where family planning and HIV service integration makes technical, financial, epidemiological, and cultural sense. 

HIV and family planning professionals are in the fight to eliminate pediatric AIDS together and must leverage each other’s strengths, not just on the programmatic side, but also the research side, where the fields of contraceptive technology and HIV prevention research and development are collaborating to develop multi-purpose prevention technologies. These new technologies integrate HIV prevention, contraception, and prevention of other sexually transmitted infections.

USAID works to coordinate a response that will maximize the success of achieving an AIDS-free generation, one which reflects our interconnected reality. We are all hitched.

Learn more about how the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) works with USAID and other partners around the world to eliminate pediatric AIDS.

Tabitha Sripipatana, Nithya Mani, and Jennifer Mason from the USAID Offices of Population and Reproductive Health and HIV and AIDS co-wrote this blog. Together, these authors bring more than 40 years of combined experience in family planning and HIV research and programs. The views expressed in this blog are the opinions of the authors and do not necessarily reflect the official policies of USAID or the US government.