Despite consensus and mounting evidence challenges to improved HIV-reproductive health linkages remain.

In line with President Bushs personal commitment Congress recently voted to reauthorize the Presidents Emergency Plan for AIDS Relief (PEPFAR). In addition to calling for a major increase in U.S. spending on international AIDS tuberculosis and malaria activities the new legislation supports linkages-either directly or by referral-with a long list of ancillary services that often affect AIDS-impacted individuals and families including nutrition access to safe water and sanitation substance abuse and treatment services and legal services. It also expands programs aimed at addressing the factors that drive the pandemic for women including initiatives to reduce gender-based violence and empower women economically. The new version of PEPFAR with its broader development mission has been hailed as a significant achievement and one of the most positive legacies of the Bush administration. Despite these impressive gains there is one critical set of linkages that is lacking in U.S. global AIDS policy: linkages between HIV and reproductive health services. During the long reauthorization process a diverse set of organizations-from CARE to the International Womens Health Coalition to the Elizabeth Glaser Pediatric AIDS Foundation-pushed for but ultimately failed to secure measures that would have strengthened the role of family planning service providers in providing HIV prevention services and would have encouraged the provision of contraceptive counseling referral and even direct services in dedicated HIV programs. (excerpt)