PEPFAR has expressed a commitment to increasing gender equity in all of its interventions in partnership with both national governments and the civil sector (OGAC, 2005a, 2006b). Women and girls have a number of needs to be met in any concerted and effective response to HIV/AIDS. Many advocates emphasize the urgency of focusing on inheritance and property rights for women and girls since increased financial independence would not only reduce their vulnerability to HIV exposure, but also improve their ability to serve successfully as head-of-households after the death of their male spouses/partners, fathers, and adult children (ICRW, 2005; UNAIDS and UNICEF, 2004; UNICEF, 2006).
Of particular importance given the emphasis of family-centered care is that many women, young girls, and elderly grandmothers may need services while simultaneously serving as primary caregivers for other ill and dying family members. Interventions are necessary to reduce their vulnerability to HIV infection, as well as to enhance their ability to shoulder the long-lasting, caregiving burden. It may be unreasonable to expect women and girls to manage the physical and emotional demands of end-of-life care without skilled assistance. Moreover, women and girls, as well as other caregivers, frequently rely on their community network for assistance, which makes strong, effective, and comprehensive community-based care a necessity.
Restoration of fertility for women on ART is a growing phenomenon with some programs reporting that up to 90 percent of the pregnancies among HIV-positive women are unplanned pregnancies and 81 percent of those unplanned pregnancies are among the women receiving ART. It is essential to address linkages among HIV/AIDS treatment and care, reproductive health, and family planning services (OGAC, 2006e). Strategies are needed to support women in voluntary family planning and reproductive health, which requires integration with prevention of mother-to-child transmission of HIV, voluntary counseling and testing in family planning settings, access to ART and other necessary medications, and care in community-and home-based settings. As part of its commitment to addressing the needs of women and girls, PEPFAR has articulated opportunities for developing such linkages. While PEPFAR funds for contraception are restricted to the purchase of condoms, linkages to existing family planning and reproductive health programs are encouraged (OGAC, 2006h). Reproductive health covers a broad range of women’s health issues, including the detection and treatment of sexually transmitted infections and support for the desire of a woman or couple who are HIV-positive or a sero-discordant couple to have children safely (Fleischman, 2006). In addition, integration with treatment programs and training of ART providers to meet the reproductive health needs of their clients may be critical in addressing family planning needs since 61 percent of those receiving ART are women (OGAC, 2005a,