Integrating family planning into HIV programs

Submitted by Kintu about 4 months ago

Over the past few years, public health experts have begun to recognize the unmet sexual and reproductive health (SRH) needs, especially family planning, in HIV-positive, home-bound populations.

Following the widespread scale up of antiretroviral therapy (ART) for people living with HIV/AIDS, previously bedridden or severely ill men and women are now healthy and resuming sexual activity. Many of these individuals wish to have children, while others want to avoid pregnancy.

At the session on 'Intergration of family planning and HIV programes' held at the International Conference on Family Planning, Kampala, Uganda, 15-18 November 2009, AMedahnit Wube, from Ethiopia revealed that a study which was conducted to assess fertility desires and demand for family planning among HIV positive men and women on ART in Addis Ababa found that among 460 study participants, more than half were sexually active and felt that they needed discussions on fertility issues. Of those participants who were sexually active and not using a contraceptive method during the survey period (214), 39.7% (85) wanted to use family planning in the future.

In Kenya, HIV prevalence is currently 7.8% among adults ages 15-49, and it is higher for women (9.2%) than for men (5.8%). Among HIV-positive women, about half have an unmet need for family planning (FP). Anecdotal evidence shows that people living with HIV prefer to receive all services from one place, and women accessing FP services prefer to receive counseling and testing (CT) from a place they know and trust, such as from their family planning facility.

Prevention of unintended pregnancies and adequate birth spacing among HIV-infected women is a cost-effective and essential component of a comprehensive approach to PMTCT. The government of Rwanda for example recognizes family planning as not only a health intervention but also a priority for economic development.

HIV Counselling and Testing (HCT) and FP integration is a major opportunity to improve FP services access and to reduce unmet needs. Asking a HCT client about his or her desires for children and current contraceptive use should be a fundamental discussion with any client who engages in heterosexual sex. HCT services, in particular, can serve as an entry point into the formal health care system, not only for those who are infected and uninfected, but also for men and youth, who are two key audiences often missed with traditional or vertical family planning programs.

Integrating FP into HCT programs appears to be an excellent opportunity to reach youth and men about family planning. This is especially important in the case of youth, since many counties shows that only between 0.5%-0.8% of women aged 15-24 were using a modern method of contraception.

Field experiences of integrating SRH services with home and community based care (HCBC) programs in many countires suggest that HCBC programs are an appropriate and effective entry point for reaching people living with and affected by HIV with important SRH information and services. Healthcare professionals and counselors working at the home and community level can play an important role in increasing access to family planning services and helping HIV-positive individuals understand their reproductive choices.

Keywords: Ethiopia family planning FamilyPlanning2009 HIV/AIDS pregnancy rwanda sexual reproductive health SRH STIs TB Uganda

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