By Varina Winder, Senior Manager, Global Partnerships and Strategic Engagement, FP2020
“It really is time for the SRH world and the HIV world to be absolutely joined at the hip,” said Dr. Rachel Baggaley, from the World Health Organization, on the recent AIDS2020 panel, “One Year After ECHO: Integration in the Time of COVID,” jointly hosted by FP2020 and AVAC earlier this month.
The ECHO trial, a study conducted last year to examine whether there is an increased risk of HIV infection among three contraceptive methods – intramuscular depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD), and the levonorgestrel (LNG) – found there was no substantial difference in HIV risk among women using the three methods studied. All methods were safe, highly effective, and acceptable to the study participants. Still, the results of the study left many people dismayed at the high incidences of HIV found in participants – approximately 4% – as well as high incidences of unintended pregnancy. Considering the women and girls enrolled in the ECHO trial were in a controlled study, with access to information and resources – including PrEP – and quality counseling, a 4% infection rate is alarmingly high. Additionally, HIV advocates have worked for decades to bring the infection rate lower, and still it persists.
Dr. Baggaley noted that ECHO “shocked the world,” with its high incidence of HIV acquisition in study participants. Yet, all the panel speakers said they haven’t seen meaningful policy change since the release of the ECHO results.
We know integration can’t wait. So, in order to ensure the widest possible audience for this discussion, including those who did not attend AIDS2020, FP2020 and AVAC hosted another discussion, this time as a free-to-join webinar, last week.
Dr. Nyaradzo Mgodi of the University of Zimbabwe-University of California San Francisco Collaborative Research Program, who spoke on the panel as well as the webinar, elaborated on the need for change: “We design these beautiful programs and interventions, but we really need to engage the end users, with differentiated services for different women.”
Programs have to focus on the lives of the women they’re serving: women don’t want to only prevent pregnancy or only prevent HIV. In particular, young women and adolescent girls are simultaneously at risk for both unintended pregnancy and HIV infection. Sexual and reproductive health care that includes family planning and HIV and STI prevention and treatment services is essential to provide women and their families with the protection they need. The ECHO trial demonstrated the urgent need for investment in woman-centered programs that offer a full range of contraceptive choices and HIV prevention strategies at the same site, time, and with the same provider, and through an approach that is centered on women’s informed choice.
At the same time, the global COVID-19 pandemic has exacerbated longstanding challenges in women’s and girls’ access to sexual and reproductive health care, including family planning, and HIV and STI prevention, testing, and treatment. These include stockouts, siloed care, and limited ability to access services, whether due to clinic closures or travel restrictions. These challenges present both immediate and long-term threats to the health of women and girls, and panelists noted that SRH integration is an important mitigating strategy to the long-term impact of COVID, and Mitchell Warren, Executive Director of AVAC, ended the discussion by asking each panelist what they will personally do to advance FP/HIV integration over the coming year. Beth Schlachter, Executive Director of FP2020, said one critical next step will be to ensure FP and HIV integration is built into the next phase of the FP2020 partnership.
If you couldn’t join the recent webinar, check out the recording, as well as the newly launched srhintegration.org, which features a suite of integration resources. You can also hear from the experts featured in these conversations and more in the One/One/One campaign – where one expert speaks for one minute to answer one question about meaningful integration between family planning and HIV programming.