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Perhaps Another Elephant: Linking Contraception to HIV » Family Planning

Perhaps Another Elephant: Linking Contraception to HIV

November 6th, 2008 by maggie chen Leave a reply »

In blogging about contraception and efforts to increase its access, I realized that it doesn’t make sense to write about contraception as an isolated topic. Clearly, contraception is one part of the larger picture of sexual and reproductive health (and human rights). I think one of the most important connections to draw is that between contraceptive use and HIV/AIDS.

This Washington Post article has gone so far as to say that birth control is the ‘best-kept secret’ for an HIV-free Africa. Increased birth control access would be targeted at preventing mother-to-child transmission. Discussions of prevention of MTCT often go straight to the drugs that can be administered at birth (e.g. nevirapine), or the decision about whether to breastfeed. We rarely talk about how MTCT can be prevented by allowing women to choose to use contraception.

The article profiles a woman who, at age 27, had given birth to six children and was HIV-positive. She had been widowed, then inherited by another man, based on the community’s tradition. In terms of childbearing, the woman said, “I wanted to be done,” after she learned she had HIV.

HIV-positive mothers face difficult issues and decisions, such as the possibility of dying and leaving their children as orphans, or giving birth to HIV-positive children in rural areas where drugs for MTCT prevention are scarce. Specific attention should be give to the contraceptive needs of this group. After learning in class about the forced sterilization of women with HIV, making sure that birth control programs are structured based on a woman’s choice and not a forced decision seems especially salient.

Interestingly, before Republicans took control of the US Congress in 1996, Kenya experienced a significant decline in fertility that was fueled by widespread groups of community health workers who offered BC pills and contraceptive counseling. More recent funding for this initiative brings us back to PEPFAR. While public health officials argued for the inclusion of family planning efforts in PEPFAR, citing contraception’s crucial role in preventing MTCT, the Bush administration refused to allow PEPFAR money to be used to purchase contraceptives.

At a time when condom use has proven to be a difficult behavior to increase in the broader issue of HIV prevention, addressing MTCT prevention through increased availability of contraception could be an area of significant impact.

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2 comments

  1. jliebner@stanford.edu says:

    I’m surprised that the Washington Post would go as far as to say that birth control is the best kept secret for HIV prevention when only a small percentage of infection are MTCT when nevirapine is available. Non condom contraception is useless to prevent HIV transmission in the first place, and in my mind, is the ultimate method of preventing HIV transmission without changing societal views on male sexuality and promiscuity.

  2. Max R says:

    I agree with you that birth control has to do with HIV/AIDS transmission, and I would take your argument a step beyond MTCT. Birth control is a way for women to control their own reproduction. The underlying reason for promoting birth control is that women should be able to control their own reproduction. But promoting birth control has to do with more than making contraceptives available, but promoting a woman’s right to use those contraceptives and decide when to/when not to engage in sex. Women’s lack of control over their own sexuality in a hierarchical gender structure leads to the unchecked growth of STIs. I think broadly promoting birth control, as both the material contraceptive and the underlying idea that women deserve control over their reproduction and sexuality, would deal a significant blow to HIV/AIDS transmission.

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