is senior associate

at the Center for Strategic

and International Studies HIV/AIDS Task Force

During his recent Africa tour, President Bush rightly highlighted the significant results of his HIV/AIDS strategy, and indicated that he would "change the tactics" if the strategy is not working. Despite impressive gains, there is an important area where U.S. HIV/AIDS policy is lacking: prevention for women. Curbing the epidemic requires expanding women's access to effective HIV prevention services and preventing babies from being born with HIV. This means integrating HIV/AIDS and reproductive health/family planning programs.

Congress is now considering $50 billion over the next five years for the U.S. AIDS program, the President's Emergency Plan for AIDS Relief (PEPFAR). But it does not increase funding for reproductive health programs. Despite the ideologically charged atmosphere in Congress about family planning, the clear benefits of integrating HIV/AIDS goals with reproductive health programs make it crucial to move beyond this polarization. The next phase of PEPFAR needs to emphasize HIV prevention, and this should include integrating family planning and HIV/AIDS programs.

This is critical. Women now constitute 60 percent of those living with HIV/AIDS in sub-Saharan Africa, and young women account for three-quarters of those aged 15 to 24 living with the virus.

Providing access to family planning for these women can reduce the number of unintended pregnancies leading to children born with HIV as well as the number of child deaths. Integrating HIV services at family planning clinics extends their reach to large numbers of sexually active women who could be at risk of HIV.

There already are programs in AIDS-affected countries that link reproductive health and AIDS prevention. The range of integrated programs includes several PEPFAR-supported projects, which demonstrates that U.S. HIV/AIDS programs can create space for reproductive health-HIV integration.

In Kenya, for example, programs combine HIV testing and family planning services. The clients for both types of service are sexually active and in their reproductive years, putting them at risk of HIV infection. If the clients have an interest in preventing unintended pregnancies, they require access to contraceptives and need to know how HIV affects contraceptive options. In South Africa, programs to prevent mother-to-child transmission of HIV have found that providing adequate anti-retroviral regimens to infected women can effectively reduce pediatric HIV and infant and child mortality, underscoring the importance of reaching HIV-positive women early in their pregnancy.

As important as it is to integrate family planning and HIV/AIDS programs, it won't be easy. One major challenge involves the enormous disparity in resources. While U.S. funding for AIDS programs has risen exponentially, family planning funding has been reduced.

And there is the reality of competing priorities. But at a time when many policy-makers, experts and advocates are debating whether U.S. funding for HIV/AIDS is undermining other critical health priorities - including child survival, maternal health and family planning - the promising approaches toward reproductive health-HIV integration illustrate ways to help strengthen the health sector overall. Indeed, family planning-HIV integration represents the kind of efficiency and long-term cost-effectiveness that should make it a priority.

With the reauthorization of PEPFAR in 2008, a new U.S. administration in 2009, and PEPFAR's ongoing choices about implementing programs, the United States has an unprecedented opportunity to integrate family planning and HIV programs to strengthen U.S. HIV/AIDS strategy. Having accomplished so much in PEPFAR's first phase, the U.S. should heed the evidence and promote this integrated approach as a key component of its AIDS policy.