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PEPFAR Newsflash: Reproductive Health is a "clean word"!
by: AFY_Brian
Tuesday, March 24, 2009 at 1:55:00 PM EST
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On Wednesday, March 18, I attended a presentation entitled “It’s not Over: Global AIDS Funding in an Era of Uncertainty,” sponsored by Physicians for Human Rights (PHR) and Georgetown University. The speaker, Dr. Peter Mugyenyi, Executive Director of Uganda’s Joint Clinical Research Center, pioneered the administration of anti-retroviral (ARV) therapy on the continent of Africa.
 
During his introduction of Dr. Mugyenyi, former U.S. Global AIDS Coordinator, Ambassador Mark Dybul and current co-Director of the O’Neill Institute for National and Global Health Law at Georgetown University, cited Dr. Mugyenyi’s ARV treatment and care delivery strategy as the model for the President’s Emergency Plan for AIDS Relief (PEPFAR).
 
Dr. Mugyenyi expressed gratitude to both Ambassador Dybul and the American people in the opening sections of his speech. He also noted that PEPFAR’s immense successes, particularly in terms of treatment access, had made an enormous difference. He stressed that the difference between people accessing life-saving interventions and not, was really a question of political will and not simply one of resource availability. 
 
But it was his statement about prevention that really gave me goosebumps. He called for a redesigned prevention strategy that would address the realities of the epidemic in 2009. Mugyenyi noted that women are at a higher risk of infection, not just for biological reasons, but particularly because of the social and political marginalization that they face caused by a system of gender inequality. “The epidemic has changed,” Mugyenyi said.

“Many people say that reproductive health is a dirty word. It becomes even dirtier when you call it ‘family planning.’ But it is not a dirty word. It is a clean word. And integration of reproductive health services with HIV testing and care services is critical for women’s health.” 
 
Let’s take a moment to reflect! The doctor whose program was the basis for the President’s Emergency Plan for AIDS Relief (at least according to former U.S. GAC Dybul), said that “reproductive health is a clean word,” and that the “integration of reproductive health services with HIV” programming should be a priority for the future of PEPFAR’s implementation. 
 
Feels good, doesn’t it? Having spent the last two years fighting for improvements to PEPFAR’s prevention policies toward young people and women, Dr. Mugyenyi’s statements really made my day.
 
There was just one down side -  while Dr. Mugyenyi focused on the specific vulnerabilities of very young children and women to infection, he did not elaborate on the particular needs of adolescents. According to UNAIDS, young people under the age of 25 comprise 45 percent of all new infections. Young people must be at the core of any new strategy. The stigma of sex blocks the information and resources critical to the prevention of transmission among youth.  Dr. Mugyenyi’s point, that reproductive health care must be integrated with HIV testing and care services, would not only serve women, but also young people. Adequate sexual and reproductive health care resources for young people would serve to help normalize sexual health among adolescents and young adults, thus weakening the power of stigma to fuel new infections transmitted through unprotected sex. 
 
As Dr. Mugyenyi is a pediatrician, I am sure that he is aware of the epidemic among youth. But we must all ensure that the realities of HIV among adolescents are never an afterthought when we discuss prevention strategies.
 
Fifteen years after the International Conference on Population and Development (ICPD) in Cairo, Egypt, where participating country delegations established that young people have the right to medically accurate information and evidence-based care for their sexual and reproductive health, the inclusion of adolescents and young adults in HIV prevention strategies should be a given. Well, here we are fifteen years later and we are still fighting for inclusion.
 
Let’s take full advantage of this political springtime – this new beginning -  in the United States by demanding a change in U.S. global AIDS policies.
 
Just as we knew that ARVs saved lives and used our “political will” to make the impossible possible (their delivery in low-resource settings), we can garner that same “political will” to ensure that comprehensive, medically accurate information about the prevention of HIV - especially for young people - also be available. 
 
In a closing anecdote, Dr. Mugyenyi noted that, before PEPFAR was a household acronym, he sat in a meeting of public health officials in Uganda. The group collectively stated that anti-retroviral delivery could never take place in Uganda on the same scale and with the same efficacy as it had in the United States. Dr. Mugyenyi said he got up and left the meeting, never to return. He had decided not to waste his time with the naysayers, but to invest in making antiretroviral therapy a reality in his country. Today, Dr. Mugyenyi proudly noted, anti-retroviral delivery and adherence to treatment in Uganda is “just as good” and in some cases “better” than in the United States.  
 
This is a strategy I have not yet employed in my fight to have U.S. global HIV prevention policy reflect the realities of young people’s lives, but it sounds like it’s a tactic waiting for the moment. Next time policy makers smugly tell me that young people cannot handle comprehensive HIV prevention education, or do not need access to sexual and reproductive health services, I’ll be sure not to let the door hit me on the way out. 

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Hiding the sometimes harsh realities of live from young people is not going to save them from it- it's going to make them more susceptible to it. The faster the world learns that, the better. And it's our job to tell them! Good post.
# Posted By Mahayana | 3/24/09 04:19 PM | Report | Reply
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