Family planning needs in the context of the HIV/AIDS epidemic: Findings from a three-country assessment covering Kenya, South Africa and Zimbabwe

One of the key contours of the post-ICPD era is the broadening of family planning programs to encompass reproductive health needs and rights. In sub-Saharan Africa, such an agenda has been blurred by HIV/AIDS, the leading cause of death among women and men of reproductive ages. Family planning (FP) programs are key pillars to the reduction of maternal mortality and the prevention of HIV infections and unwanted pregnancies. However, we do not know much about how the HIV/AIDS epidemic is impacting on family planning needs, services, and policies. Family Health International, in collaboration with Ministries of Health in Kenya, South Africa and Zimbabwe, has recently conducted an assessment of how the HIV/AIDS epidemic is affecting family planning needs and services in these countries. This paper presents findings from this assessment, namely: the current status of FP and HIV/AIDS programs, needs and opportunities for FP programs and services, and possible strategies for strengthening FP programs and services in the context of the HIV/AIDS epidemic. Background IN 2004, an estimated 28 million adults and children were living with HIV/AIDS in sub- Saharan Africa, making it by far the region most affected by the epidemic. With only 10 percent of the world population, sub-Saharan Africa accounted for at least 75 percent of the estimated 3 million global AIDS deaths in 2004 (UNAIDS, 2004). To address the escalating HIV/AIDS burden, government health departments are reallocating health resources, shifting the training and deployment of health personnel, and changing the overall organization of the public health infrastructure. Consequently, the region has seen an expansion of HIV prevention and care programs and services, such as prevention of mother-to-child transmission (PMTCT) programs, Voluntary Counseling and Testing (VCT) centers, provision of anti-retroviral therapy (ART), and home-based care. However, these programs are evolving as vertical programs and lack the provision of the traditional reproductive health (RH) services. As a result, attention and resources are being diverted from efforts to provide comprehensive RH services, as recommended by international conventions such as the 1994 International Conference on Population and Development. Family planning (FP) falls within the realm of traditional RH services and is an important strategy for preventing HIV infection. For HIV-positive women, the prevention of unwanted pregnancies is critical for preventing mother-to-child transmission of HIV. While prophylactic treatment during pregnancy greatly reduces risk of transmission from