Statement on ECHO Trial Results

Women and girls, no matter where they live, have the right to make their own decisions about their bodies and their sexual and reproductive health and lives.

Unfortunately, in Sub-Saharan Africa, 53 million women and girls still have an unmet need for modern contraception. Women and girls in the region are also disproportionately affected by HIV, with 74% of all new HIV infections occurring among adolescent girls and young women.

As family planning and HIV advocates, we welcome the ECHO trial—the first and most rigorous of its kind. The results underscore an urgent need to do more to address the unacceptably high HIV incidence among women, and to provide high quality integrated family planning and HIV information, services and supplies—including access to a range of highly effective contraceptive methods as well as pre-exposure prophylaxis—to support women’s agency and autonomy and help them to assess their individual risks for both unintended pregnancy and HIV.

Women and girls don’t compartmentalize their needs and desires: decisions and services around family planning, contraception, HIV treatment or prevention and other health issues must be rights based, integrated, respectful, and woman centered. Women and girls must be able to make informed decisions about their health, including about contraception and HIV prevention or treatment services.

Offering family planning and HIV/ AIDS services together is central to ensuring universal access to reproductive health care and HIV prevention, treatment and support. And yet, the ECHO trial teaches us that even this is not enough. A 3.8 % infection rate even among participants receiving the highest standard of care shows us that we must do far more to improve women’s health and prevent HIV and other sexually transmitted infections.

We call on donors, governments and civil society to:

• Center women’s rights, voices, and experiences. Women must be involved in every level of decision making when it comes to HIV and family planning— from research design to program approaches and policymaking. Engaging civil society, including women-led and serving organizations, can help to promote better integration and outcomes because these groups have a cultural, political, and social understanding of their communities.
• Address the gendered socio-economic factors and structural barriers which undermine women’s and girls’ human and sexual and reproductive health and rights, including HIV outcomes. This includes gender-based violence, harmful cultural norms, and laws and policies which reduce their political and economic power.
• Provide robust and flexible funding for both family planning and HIV/AIDS programs and promote policies that support integrated programming. These policies should ensure that individuals receive the services they need, regardless of their entry point into the health care system.
• Expand contraceptive method mix and increase investments in research and development to further improve HIV prevention and contraceptive options for women, including dual-purpose products that can protect against both.
• Improve the integration of HIV and family planning services at all levels. To better deliver for women and ensure equitable access to high-quality family planning and SRH and HIV services, family planning and HIV supply chains should be integrated; reproductive health and HIV/AIDS agencies should closely coordinate; health care providers should be trained in integrated care, and create strong monitoring and evaluation frameworks are needed to measure and incentivize FP/RH and HIV/AIDS integration.
• Ensure equitable access to high-quality family planning and SRH and HIV services. National governments should develop and implement policies in support of access, affordability and equity, particularly as they build out coverage and financing schemes in the name of universal health coverage. To ensure financial sustainability and equitable access, insurance schemes and respective packages of services must include SRH information and services—including family planning, safe, legal and voluntary abortion and post-abortion care, pregnancy-related services and HIV prevention and treatment. 

Endorsing Organizations

• APHA
• AVAC
• Family Planning 2020
• ICWEA
• PAI
• Planned Parenthood Federation of America