Planning for Microbicide Access in Developing Countries

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Planning for Microbicide Access in Developing Countries

Similarly, many civil society groups have beenestablished to advocate for greater politicalattention to AIDS, and to provide healthcareand support. Treatment advocacy groups,organisations of people living with HIV,women’s groups and faith-based organisationshave been key actors. The early advocacywork of ACT/UP in the US was extremelyeffective, and has led to the creation ofmany similar advocacy groups, including theTreatment Action Campaign in South Africa,The AIDS Support Organisation (TASO) ofUganda, the International HIV/AIDS Alliance,the International Council on AIDS ServiceOrganizations (ICASO) and the Society forWomen and AIDS in Africa (SWAA).To date, there has been limited integrationof civil society provision of family planningand broader sexual and reproductive health(SRH) services with HIV/AIDS advocacy andservices. The existence of different fundingstreams, an initial focus among HIV/AIDSorganisations on care for people living with HIVand, in some instances, a focus on work withmarginalised communities who are not alwayswell-served by SRH-focused organisations allhelped institutionalise a new, separate set oforganisations and activities to address HIV/AIDS in some countries. Donor conditionalitieson funding (e.g., the US “Mexico City policy,”which denies funding to organisationsproviding abortion counselling or services) mayhave also encouraged the separation of SRHand HIV/AIDS services. However, despite someoperational challenges and different emphasesbetween the two fields, links between SRHand HIV/AIDS are now being made (InteractWorldwide 2006; IPPF 2006).Microbicides will be used by reproductiveagewomen, who are often already servedby family planning and reproductive healthorganisations. Microbicide introduction willrequire community mobilisation and support,and would benefit from improved civil societycoordination on SRH and HIV/AIDS.GOVERNMENT PROGRAMMESProviding Access to Services for the PoorGovernment health services play an importantrole in providing family planning services (seeFigure 3). The first government-led nationalfamily planning programme was launchedin India in 1959, followed by other countriesin the 1960s and 1970s. By 1976, seven inten developing country governments (109countries) provided some form of supportfor contraception. By 2001, this number hadincreased to 184 countries (UN 2003).In addition to establishing programmes todirectly provide services, governmental supporthas facilitated access to contraceptives bypublicly legitimising family planning, educatingthe public, addressing cultural or professionalopposition and supporting a range of nationalpolicy initiatives, such as increasing theminimum age-at-marriage, allowing tax-freeimportation of supplies and removing lawsthat might inhibit programme implementation(e.g., regarding provision of family planninginformation to key populations).Historically, the majority of international donorsupport for reproductive health and familyplanning has gone to governments. Initially,donors supported independent verticalPLANNING FOR MICROBICIDE ACCESS IN DEVELOPING COUNTRIES: Lessons from the Introduction of Contraceptive Technologies 15

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