Steven W. Sinding
1 December 2005

World AIDS Day this week spotlighted the world’s failure so far to achieve the day’s theme of “Stop AIDS: Keep the Promise.” But it can still happen. The European Union is pointing the way.

Field reports are sobering: global spending against HIV/AIDS has more than quadrupled in the past decade, but infection rates are still rising worldwide. More than 60,000 people are dying of AIDS every week – 23 million so far, half of them women, and no end in sight. What should we do differently?

We should first link programmes narrowly targeted against AIDS such as condom distribution and publicity campaigns with programmes that provide more basic sexual and reproductive health care and education, such as family planning services, especially for girls and women.

Where those links have been forged, such as in Zimbabwe and, until recently when US funding forced an about-turn in a comprehensive approach, Uganda, HIV infection rates are slowing and progress is being made.

So compelling are the field reports that the European Union’s World AIDS Day 2005 statement says integration of HIV prevention programs into these other health services is among the “critical components of a comprehensive and evidence-based response” to the pandemic.

The statement explicitly rejects “partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness” – that is, abstinence-only sex education campaigns that are irrelevant for married women, for instance.

In much of the developing world, public health systems are rudimentary. It wastes money, resources and time to send expensive anti-retroviral drugs, for example, to areas that lack health care facilities to distribute them, or to clinics that lack running water or electricity, much less trained personnel to administer the drugs. Both drugs and condoms are useless in stopping new infections if recipients lack understanding of which behaviors transmit HIV. In Africa, where the pandemic is worst, teen-age girls and married women in their 20s and 30s are the hardest-hit group.

Meanwhile, widely available family planning clinics and outreach workers often provide the only health care of any kind in rural and poor urban areas. Their broad presence reflects governments’ general grasp of – and investment in – the fact that smaller families and slower population growth spur economic development. But these facilities have not yet been fully mustered against HIV/AIDS. In fact, their funding is declining as governments and donors set up separate AIDS programmes.

The European Union has strongly stated the need to integrate HIV/AIDS prevention, testing, counseling and treatment programmes into existing sexual and reproductive health services and programmes. It is past time to heal this breach.

Most of the world’s poor could get their AIDS prevention information, testing and care from family planning clinics and organizations like ours that they already consult for comprehensive sexual and reproductive health care information and services.

Government and non-governmental family planning organizations have spent decades setting up networks and facilities to provide contraceptive information and materials, prenatal and post-natal care and education, and safe motherhood training and equipment.

Successful family planning programmes already incorporate the cultural aspect that many anti-AIDS projects leave out. We work, for example, against child marriage that not only ends a girl’s education and limits her future but exposes her to AIDS from older, sexually experienced men.

We fight cultural preferences for sons and stereotypes of male sexuality that condone irresponsible behavior. We urge parents to send their daughters to school, knowing that will help empower them to negotiate safer sexual practices and support their families without recourse to “sugar daddies.” We educate new mothers, including those who are HIV-positive, on how to protect their newborns from infection and from other childhood diseases.

All responsible reproductive health care organizations already incorporate this kind of AIDS prevention work into their programmes, but AIDS activists could collaborate with them to maximize their impact. The EU urges the world to “utilize all approaches known to be effective, not implementing one or two selective approaches in isolation.”

We couldn’t agree more.