title: The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration.
abstract: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception.
  
  
  
  Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers.
  
  
  
  Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling.
authors.affiliation: Office of Population and Reproductive Health, U.S. Agency for International Development, Arlington, VA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mason
authors.affiliation: Division of Global HIV and AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Medley
authors.affiliation: Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Yeiser
authors.affiliation: HIV/AIDS Prevention Program, U.S Department of Defense, Falls Church, VA, USA.
authors.forename: Vienna R
authors.initials: VR
authors.lastname: Nightingale
authors.affiliation: Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA.
authors.forename: Nithya
authors.initials: N
authors.lastname: Mani
authors.affiliation: Office of Population and Reproductive Health, U.S. Agency for International Development, Arlington, VA, USA.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Sripipatana
authors.affiliation: Division of Global HIV and AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Abutu
authors.affiliation: Office of Population and Reproductive Health, U.S. Agency for International Development, Arlington, VA, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Johnston
authors.affiliation: Office of the U.S. Global AIDS Coordinator, U.S. Department of State, Washington, DC, USA.
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
mesh_terms: D003376:Counseling; D005191:Family Characteristics; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D009042:Motivation; D011247:Pregnancy; D057545:Social Stigma
keywords: Family planning; HIV; United States Government; integration; safer pregnancy; serodiscordant couples