Increasing Availability of Contraception in Africa Could Prevent More Pediatric HIV Cases Than Antiretrovirals Alone, Researchers Say

Increasing the availability of contraception for women in Africa could prevent tens of thousands more pediatric HIV cases at a lower cost than providing antiretroviral treatment to pregnant women, some researchers have said recently, the Washington Post reports. Although antiretroviral drugs can reduce rates of mother-to-child HIV transmission by more than 50%, studies indicate that about one in 10 HIV-positive African pregnant women have access to the drugs. According to Family Health International, programs providing antiretroviral drugs to pregnant women prevented 101,000 cases of pediatric HIV between 1999 and 2006. Contraception prevents the births of 173,000 HIV-positive infants annually, the group says. According to Ward Cates, head of research for FHI, contraception also "tends to be the best kept secret in HIV prevention." Surveys conducted among women who are aware of their HIV-positive status indicate that most do not want to become pregnant again because they think they could transmit the virus to their infants, the Post reports.

Despite growing research about the effectiveness of contraception in fighting pediatric HIV, U.S. and other international funding for birth control programs has continued to decline, the Post reports. Washington, D.C.-based Population Action International found that when adjusted for inflation, President Bush's proposed fiscal year 2008 budget includes funding levels for contraception that are less than one-third the amount spent in 1995.

According to the Post, U.S. funding for contraception began to decrease in 1996, when Republicans took control of Congress, and money that was provided came with "new restrictions." Bush in January 2001 banned funding to groups that provided or promoted abortion services overseas. The policy affected Family Health Options Kenya and Marie Stopes Kenya -- two of the largest distributors of birth control in Kenya -- which did not provide abortions but were affiliated with London-based organizations whose members helped provide them in other countries. The two groups were forced to close five family planning clinics after losing the U.S. funding.

USAID once said that Kenya had the "most spectacular decline in fertility ever recorded in Africa" because of international funding for radio programs, contraception and community health workers. However, surveys conducted in recent years have found significant shortages of contraception, as well as a lack of capacity to deliver such devices. According to the Post, birth rates in Kenya are rising again, and the United Nations has almost doubled its long-term projections for Kenya's population from 44 million to 83 million by 2050. "When the U.S. money got stuck somewhere, the program collapsed," Geoffrey Luttah, head of the Family Health Options Kenya clinic in Kisumu, said, adding, "We are only reaching very few people who can afford to come to the facility. So the area covered became very narrow. We are denying contraceptives to many people."

Some Bush administration scientists advocated re-establishing international family planning programs when Bush created the President's Emergency Plan for AIDS Relief in 2003, the Post reports. They conducted a study that year showing that even a small increase in contraceptive access could prevent nearly three times the number of pediatric AIDS-related deaths as antiretroviral programs for pregnant women.

However, top PEPFAR officials would not allow funding to be used to buy birth control, Daniel Halperin, one of the study's authors and now a researcher at the Harvard School of Public Health, said. "The first few years were a nightmare," he said, adding, "You couldn't even say the words 'family planning.' This is probably the clearest example of when PEPFAR politics trumped evidence."

According to the Post, PEPFAR officials have said they did not object to family planning but chose to fund initiatives they thought were more directly related to HIV/AIDS. "There are many, many issues out there, so the best that PEPFAR can say is we are focused on HIV," Michele Moloney-Kitts, a top PEPFAR official, said (Timberg, Washington Post, 12/16).

Back to other news for December 2007