The United Nations estimates that 2.5 million children are infected with HIV / AIDS, with nearly 90 percent of them in sub-Saharan Africa. Activists in the fight against the disease say one of the best ways to prevent mother-to-child transmission of the HIV virus is to prevent unintended births. From Washington, reporter William Eagle has the story.
In recent years, anti-retroviral AIDS drugs have been in the forefront of the fight to prevent the spread of the disease from a mother to her baby.
The most influential program in fighting HIV/AIDS in Africa is the President's Emergency Plan for AIDS Relief, or PEPFAR. Among other things, PEPFAR funds treatment and prevention efforts.
Principal deputy AIDS coordinator and chief medical officer for PEPFAR Dr. Thomas Kenyon notes that the United States has been a global leader in preventing mother-to-child transmission, called PMTCT.
"To date," he says, "we have supported PMTCT services for women in more than 10 million pregnancies, of whom 800,000 were found to be HIV positive."
He says PEPFAR's support for anti-retrovirals has helped avert 150,000 infant infections.
But some health activists note that despite much progress, only one in 10 HIV-positive women in Africa has access to the medications. They say a more effective way to stop infections is preventing unintended pregnancies among HIV-positive women.
According to recent newspaper reports, researchers with the U.S.-based group Family Health International say contraception is more reliable and less expensive than AIDS drugs.
Policy analyst Katie Porter, of Population Action International in Washington, says PEPFAR could be far more effective by strengthening its prevention programs - including mother-to-infant prevention - by making contraceptives available to those who want them.
"The immediate concern," says Porter," is that PEPFAR is not supporting access to [a wide variety of] contraceptives. While they support condom use, which is important, they are not providing other contraceptive commodities to women in what would be a very appropriate setting. If you can intervene when women come in for these services and offer them contraceptives, you help to reduce unintended pregnancies among HIV-positive women, and that would further enhance these programs."
PEPFAR supporters say its job is preventing the transmission of HIV/AIDS, and the only contraceptive that does so is the condom. But they note that USAID sponsors family planning programs that include a wide variety of contraceptives, including IUDs, oral tablets and injected medications such as NORPLANT.
When President Bush introduced PEPFAR five years ago, he proposed a budget of $15 billion for its first five years, the majority of which would benefit 15 focus countries - 12 of them in Africa. [They include: Botswana, Ivory Coast, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. The others are Guyana, Haiti and Vietnam].
Recently, it was announced that that goal would be surpassed - for a total of nearly $19 billion.
But Porter says only a very small portion of that money is earmarked for family planning and reproductive health, despite the critical role it plays in helping prevent HIV infection. As an example, she addressed President Bush's 2008 budget.
She says,"If you look at PEPFAR's 15 focus countries, where efforts to address the needs of women and girls and to address HIV prevention is paramount, we are seeing a decrease, or flat-lining, of funding for international family planning [in 10 of the countries]."
Population Action International says four of the 15 focus countries receive no family planning assistance, while only one - Rwanda - is marked to receive a small increase. The group says all 11 countries have high fertility rates and an unmet need for contraception.
PEPFAR supporters say that it is the US Congress that authorizes and appropriates funding, with the president's approval. That includes deciding on the amount of money allocated to the agency in charge of the bulk of family planning services, USAID. They note that PEPFAR's goal is preventing the transmission of HIV/AIDS. Therefore, PEPFAR's only involvement in family planning is in recommending methods that prevent the spread of the disease - using condoms or practicing abstinence.
Porter says advocates and providers are also concerned about some of the rules that are attached to PEPFAR's funding. For example, one says that at least one-third of all the prevention funds must go to programs that only teach abstinence. Some researchers complain that there is no scientific evidence that teaching restraint alone is effective.
Porter says organizations that receive PEPFAR funding must also sign a pledge opposing prostitution. But prostitutes are at high risk of HIV and unintended pregnancies.
She says, "There is concern in the field that having such a statement would alienate the very people they are aiming to provide services to."
PEPFAR officials disagree. They say their programs target everyone, including high-risk groups like those who practice prostitution.
They say PEPFAR is supporting the most diverse prevention strategy of any donor, which addresses prevention of mother-to-child transmission, as well as preventing sexual transmission by delaying sexual activity, being faithful, and using condoms.
Kenyon says from 2004 to 2007, the United States provided 1.8 billion condoms worldwide - more than all other donors combined.
At the same time, the U.S Government has a voluntary family planning and reproductive health program, through USAID's Office of Population and Reproductive Health.
USAID has provided an average of $440 million in family planning in the past five years, more than the average $427 million provided during the Clinton administration.
Kenyon says this program is coordinated with PEPFAR to ensure appropriate linkages between these two distinct programs.
"We have a number of countries where we are adding counseling and testing to family planning centers," he says. "[We are also] adding services for prevention of mother-to-child transmission as is done through the Africa Medical Research Education Foundation in Kenya. [It] has introduced PMTCT services in more than 30 family planning centers and reached more than 20-thousand women. We [are also improving] linkages between HIV programs and family planning programs. [We are also] linking family planning programs with HIV care, and to the prevention of mother-to-child transmission."
PEPFAR officials say that a comprehensive strategy is necessary - which combines the expertise of PEPFAR in fighting HIV with the family planning programs of USAID.
