Global AIDS policy and women's health

IN SPITE OF scientific and medical advances in recent years, the AIDS pandemic remains the greatest public health crisis of our time. Each day 6,000 people die of AIDS and there are 7,000 new infections. These statistics are difficult to comprehend until you see the faces of those most often affected - young women, between the ages of 15 and 24, living in sub-Saharan Africa.
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The United States could do a better job saving their lives if our leaders would place the best public health practices over political compromise. Congress should stipulate in its funding of overseas AIDS assistance that prevention, testing, and treatment of this disease should be linked with family-planning services in Africa. In many cases, US AIDS assistance is not provided at clinics with family-planning services because of conservatives' concern that such services might provide or advise on abortions.

Research has repeatedly shown that integration of HIV services within the context of women's health could save the lives of hundreds of thousands of women and, if pregnant, their newborns. The entry point to the healthcare system for many African women is the family-planning clinic. Timely access to messages on HIV prevention and life-saving treatments can slow the AIDS pandemic.

Three weeks ago I walked through a women's ward in the national referral hospital in Uganda with a local physician. I held the hand of a beautiful 18-year-old woman diagnosed with end-stage AIDS. Through the look of hope in her eyes, she begged not to be yet another statistic lost to a preventable and treatable disease. The majority of the women we assessed were dying of AIDS. Seventy percent of those admitted to the hospital share this fate.

"If only we could identify these women earlier we could reverse this outcome. Anti-retroviral drugs are available but most are too far advanced in the progression of their disease to benefit," the physician stated. "When they first come seeking ante-natal care or family planning we could educate, treat, and prevent such dire results. Most of these young women fall through the cracks due to fragmented healthcare."

Translating these eyewitness accounts and the evidence-based research into life-saving policy has proven difficult for congressional leaders. The President's Emergency Plan for AIDS Relief is currently being reauthorized. This vital program, which has saved millions of lives over the last five years, has been heralded by many on both sides of the aisle as the most significant legislative achievement of this administration. The proposed new budget is $50 billion for the next five years, a significant increase over the original program. As welcome as the new funding is, Congress should take this opportunity to apply lessons learned.

The bill coming before the Senate makes no mention of linking HIV and family-planning services. To avoid controversy with conservative policy makers, the bill's Democratic drafters left linkages out completely.

Those of us who have worked in Africa know that family planning and reproductive health services are in fact not code words for abortion, as some suggest. Women's healthcare means access to contraception, prenatal care, safe labor and delivery, postpartum and newborn care, as well as treatment for sexually transmitted illnesses. Linking women's healthcare with HIV services should be obvious. Any restriction in moving integration of care forward is a big step backward in the US program's prevention and treatment efforts.

There is still time to address this critical component of our global AIDS policy when the bill is debated in the Senate. Bold leadership calling for effective, evidence-based interventions and not ideology is necessary. Senators can help women a world away by pushing for inclusion of strong language in the final Senate bill to support the integration of HIV services and family-planning programs.