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Funding failure

May 19, 2011

By ignoring the family planning side of HIV/AIDS prevention and treatment, the international community is failing girls in developing countries. Young women should instead receive more holistic treatment, activists say.

African women crossing a stream
African women want family planning services tooImage: UN Photo/Albert Gonzalez Farran

Governments and non-profit groups around the world are working to stop the spread of HIV/AIDS and ensure that every child born is a wanted child. Many of the approaches they use - increased condom use, education and better communication between partners - can be used to achieve both goals.

But over the years funding for the international programs addressing these causes has come out of separate pots. That's been to the disadvantage of girls and young women in developing countries, according to the participants of a meeting on girls, population and development held in Paris this week ahead of a two-day G8 heads of state summit to start May 26.

For example, US funding for international HIV/AIDS programs skyrocketed from $614 million (432 million euros) in 2001 to $5.6 billion in the 2012 budget request, according to the Kaiser Family Foundation. The money allocated for family planning and reproductive health, on the other hand, increased from $376 million in 2001 to $625 million in 2012.

A woman shows a female condom to a workshop in Africa
The correct use of the female condom can prevent pregnancy and HIV infectionImage: picture-alliance /dpa

The funding split creates barriers that can keep girls from getting the help they need to live healthy lives, according to Heather Boonstra of the Guttmacher Institute.

"Why have traditional approaches to prevention failed? I really believe it's a failure on our part to approach girls holistically, recognizing that their concerns are not exclusive to the AIDS virus in particular," she said. "The fact is that young women, especially in countries or regions of the world where HIV is prevalent, are concerned about and want to protect themselves from unplanned pregnancy and HIV."

Boonstra said her institute's research found that young women in Sub-Saharan Africa tend to use condoms because they don't want to get pregnant, not out of concern over contracting HIV. Programs that only focus on HIV/AIDS prevention thus miss an opportunity to reach these girls, she said.

Avoiding stigma

Providing family planning and HIV/AIDS prevention services in one location is also a matter of convenience, according to the meeting's participants, and convenience can be a big factor when the walk to the nearest clinic might take several hours.

Easy access to information and treatment makes a big difference when it comes to dealing with HIV/AIDS, said Silvia Ssinabulya, a member of the Ugandan parliament.

An HIV counseling and testing center in Uganda
Family planning and HIV/AIDS information at one spot is convenient and effectiveImage: DW

"Those of us who come from countries where HIV/AIDS is at a higher scale know the trouble it is if you go for testing and then you have to come back tomorrow for your results and then you have to come back another day for your treatment," she said. "It is so cumbersome, and it's one of the issues that stands in the way for management of HIV/AIDS."

But in addition to being convenient, offering both birth control and HIV/AIDS information at one spot can shield women from the shame often associated with HIV/AIDS, according to Gill Greer, director-general of the International Planned Parenthood Federation (IPPF).

"I can go to the dispensary here and nobody knows why I'm there because it could be for family planning, which is fine, or it could be for HIV, which is covered in discrimination and stigma," Greer said a woman had told her.

Pharmaceutical focus

Jenny Tonge, a Liberal Democrat member of the House of Lords in the UK, criticized the massive increase on funding for AIDS programs in the last 10 years, suggesting that a push for former US President George W. Bush for more money for AIDS had put too much emphasis on drugs to the benefit of pharmaceutical countries.

"People were saying, 'can't we have integration, can't we be delivering family planning at the same time?' But no, it had to be drugs," Tonge said.

AIDS drugs in the foreground and a woman in the background
There have been significant advances in HIV/AIDS treatmentsImage: AP

While Tonge said she didn't want to cut programs providing antiretroviral treatments to people infected with HIV, she added that money could be used more effectively if family planning were also taken into account.

Just as the same doctor might advise a patient on both HIV and pregnancy prevention, some medical advances in the future might provide women and girls with protection from both. Celine Mias, a representative of the International Partnership for Microbicides suggested that a vaginal ring containing the antiretroviral drug dapivirine had been shown to be partially effective in protecting women from HIV infection.

Similar vaginal rings are already being used in many countries to deliver contraceptive hormones. Mias said when the microbicide ring is perfected, it would be possible to create a ring that provided both birth control and antiretrovirals for women.

Author: Holly Fox, Paris
Editor: Sean Sinico