Increasing Availability Of Contraception In Africa Could Prevent More Pediatric HIV Cases

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Increasing the availabilityof contraception for women in Africa couldprevent tens of thousands more pediatric HIV cases at a lower cost thanproviding antiretroviral treatment to pregnant women, some researchers havesaid recently, the Washington Post reports. Although antiretroviraldrugs can reduce rates of mother-to-child HIV transmission by more than 50%,studies indicate that about one in 10 HIV-positive African pregnant women haveaccess to the drugs. According to Family HealthInternational,programs providing antiretroviral drugs to pregnant women prevented 101,000cases of pediatric HIV between 1999 and 2006. Contraception prevents the birthsof 173,000 HIV-positive infants annually, the group says.

According to Ward Cates,head of research for FHI, contraception also "tends to be the best keptsecret in HIV prevention." Surveys conducted among women who are aware oftheir HIV-positive status indicate that most do not want to become pregnantagain because they think they could transmit the virus to their infants, the Postreports.

Despite growing research about the effectiveness of contraception in fightingpediatric HIV, U.S. and other international fundingfor birth control programs has continued to decline, the Postreports. Washington, D.C.-based Population Action International found that when adjusted forinflation, President Bush's proposed fiscal year 2008 budget includes fundinglevels for contraception that are less than one-third the amount spent in 1995.

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According to the Post, U.S. funding for contraceptionbegan to decrease in 1996, when Republicans took control of Congress, and moneythat was provided came with "new restrictions." Bush in January 2001banned funding to groups that provided or promoted abortion services overseas.The policy affected Family Health Options Kenya and Marie Stopes Kenya -- two of the largest distributors of birthcontrol in Kenya-- which did not provide abortions but were affiliated with London-basedorganizations whose members helped provide them in other countries. The twogroups were forced to close five family planning clinics after losing the U.S. funding.

USAID once said that Kenyahad the "most spectacular decline in fertility ever recorded in Africa" because of international funding for radioprograms, contraception and community health workers. However, surveysconducted in recent years have found significant shortages of contraception, aswell as a lack of capacity to deliver such devices. According to the Post,birth rates in Kenya arerising again, and the United Nations has almost doubled its long-termprojections for Kenya'spopulation from 44 million to 83 million by 2050. "When the U.S. money got stuck somewhere, the programcollapsed," Geoffrey Luttah, head of the Family Health Options Kenya clinic in Kisumu, said,adding, "We are only reaching very few people who can afford to come tothe facility. So the area covered became very narrow. We are denyingcontraceptives to many people."

Some Bush administration scientists advocated re-establishing internationalfamily planning programs when Bush created the President's Emergency Plan for AIDS Relief in 2003, the Post reports. Theyconducted a study that year showing that even a small increase in contraceptiveaccess could prevent nearly three times the number of pediatric AIDS-relateddeaths as antiretroviral programs for pregnant women.

However, top PEPFAR officials would not allow funding to be used to buy birthcontrol, Daniel Halperin, one of the study's authors and now a researcher atthe Harvard School of Public Health, said. "The first few yearswere a nightmare," he said, adding, "You couldn't even say the words'family planning.' This is probably the clearest example of when PEPFARpolitics trumped evidence."

According to the Post, PEPFAR officials have said they did notobject to family planning but chose to fund initiatives they thought were moredirectly related to HIV/AIDS."There are many, many issues out there, so the best that PEPFAR can say iswe are focused on HIV," Michele Moloney-Kitts, a top PEPFAR official, said(Timberg, WashingtonPost, 12/16).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Reportis published for kaisernetwork.org, a free service of The Henry J. KaiserFamily Foundation.

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