Reproductive Health Education for Women Stems AIDS, AGI Holds

The Guttmacher Report on Public Policy proclaims that "[a]t long last, the international community appears to be coming together in a concerted effort to combat the AIDS pandemic that has overtaken much of the developing world," citing reproductive health education efforts made by several international bodies to prevent the spread of HIV. The Joint United Nations Program on HIV/AIDS has "responded definitively" that family planning and reproductive health care are an "integral part" of the fight against AIDS, not contributing to the disease by encouraging sex or fostering population declines as some critics suggest. UNAIDS "emphasized" in a 1999 report that "reproductive health care has a central role to play in AIDS prevention, and (it) should be given the highest priority in the fight against the epidemic." AIDS, now the fourth-highest cause of death around the world and leading cause of death in Africa, is projected to create population declines in "at least" three African nations -- Botswana, South Africa and Zimbabwe -- due to "soaring" infant mortality and "sharp reductions" in life expectancy. In sub-Saharan Africa, 55% of those infected with HIV are women, who biologically are "more vulnerable" to infection than men. But the Guttmacher Report states that "the most fundamental factor accounting for women's higher susceptibility to HIV/AIDS, and the one that is perhaps the most difficult to overcome, has to do with the prevailing social, cultural and economic norms that limit the formal education women receive, the information about reproductive health available to them [and] their ability to negotiate safer sex or to say no to sex at all." In addition, Geeta Rau Gupta, president of the International Center for Research on Women, said, "HIV-positive women bear a double burden: They are infected and they are women." As a result, African women have begun to seek "more control over their lives," and the demand for family planning services has "evolved slowly" in Africa. Women "want the right to determine the timing and spacing of their children," and in turn, "a woman who has attained some degree of autonomy increases her chances of escaping HIV infection," Gupta explained. The report states that women may be motivated by the AIDS epidemic to avoid unintended pregnancy, because even for those with access to antiretroviral therapy, an HIV-positive woman who becomes pregnant is at a high risk of passing the virus to her infant during pregnancy, in delivery or through breastfeeding. Margaret Neuse, director of the U.S. Agency for International Development's Office of Population, said, "In settings where HIV or sexually transmitted disease prevalence is high, information and counseling about how to effectively avoid unwanted pregnancy should also include information about how women can protect themselves against exposure to sexually transmitted disease, including HIV." Voluntary HIV/AIDS counseling and access to confidential testing services are important for women choosing a protective contraceptive, she added. At the 1994 U.N.-sponsored International Conference on Population and Development in Cairo, a "revolutionary worldwide consensus emerged" that recognized a successful population program as one that facilitates women's autonomy and better educates them, improves legal rights and offers higher-quality reproductive and health services. The Guttmacher Report concludes, "These are at the center of the post-Cairo population agenda and, not surprisingly, at the core of successful AIDS prevention strategies as well" (Cohen, Guttmacher Report on Public Policy, 10/00).