List of FP/RH/HIV Integration-related sessions
FP/RH/HIV Integration News from the Toronto 2006 AIDS Conference compiled by Theresa Norton, Johns Hopkins Blooomberg School of Public Health/Center for Communication Programs.
New HIV Prevention Technologies with Reproductive Health Implications
- Former U.S. President William Jefferson Clinton, in a speech to the conference, commented that we need to be prepared for the outcome of male circumcision studies. He noted that, while the “jury is still out” on whether male circumcision can help prevent the transmission of HIV/AIDS, we need to be prepared for two big challenges if the answer is “Yes:” (1) Selling men on being circumcised, and (2) scaling up service delivery of circumcision methods that are safely and quickly performed. (Note: According to other conference presenters, clinical trials are being conducted in Kenya and Uganda, with interim analysis expected to be available in December 2006 and other results available in 2007 and 2008.)
- ZEBRAS, an alternative female condom design, consists of an all-latex “bikini” panty with a pouch. The pouch, inserted in the vagina, forms a complete barrier inside the user, and the panty completely covers the outside of the exposed genital area to prevent exchange of body fluids. Manufacturing and distribution is in the exploratory phase: Zebra Foundation has conducted workshops in South Africa, Zimbabwe, Uganda, Nigeria, and Senegal to obtain focus group reactions among populations such as sex workers, rural populations, and poor urban populations. Results were encouraging. See: www.zebrafoundation.org.
- The MIRA vaginal diaphragm is in clinical trial to determine its effectiveness in preventing HIV transmission. The trial is expected to end September 2006, with results available June 2007.
- New microbicides in the early stages of testing: (1) ARV-containing (both contraceptive and non-contraceptive)(Tenofovir, TMC120), and (2) vaginal rings (providing 30+ days of drug delivery).
Case Studies: Initiatives for FP/SRH and HIV/AIDS Integration
- Buddhist monks provide HIV/RH counseling and spiritual support to individuals and families in Southeast Asia. Ms. Somthong Srisudhivong, Regional AIDS Program Coordinator, Southeast Asia, Norwegian Church AID, reports, “The monks are an entry point for holistic care for HIV-positive individuals and their families.” According to Ms. Srisudhivong, monks are being trained to provide scientifically based counseling to individuals and families, and refer people to hospitals that house holistic care centers, which deliver services that include reproductive health and HIV/AIDS services. Mr. Sithonh Soundara, NCA/HIV/AIDS Program Coordinator, Norwegian Church AID, notes, “The government of Lao didn’t allow the monks to discuss condoms. Then the HIV/AIDS epidemic grew big. Now the monks talk about condoms. They also go to the schools and talk.”
- In Latin America, a vulnerable population particularly lacking in integrated SRH/HIV services is MSM who have sex with women. A sub-population, MSM who have sex with women do so in order to have children. The PROFAMILIA-Colombia project has worked to address the needs of this vulnerable population.
- South Africa’s national family planning program has played a central role in introducing the female condom. Preliminary findings suggest that promoting the female condom through family planning services has resulted in substantial uptake and sustained use. See www.interactworldwide.org for more details.
Fertility Desires of HIV-Positive Men and Women
- In a study conducted in Brazil in 2000-2002 of HIV-positive men and women, approximately 50% of men wanted to have more children, while approximately 19% of women wanted more children. In addition, bisexual men were more likely than heterosexual men to want more biological children. Yet observed health care professionals omitted discussion of reproductive health with their HIV-positive clients.
- Low-tech methods can reduce transmission of HIV and health risks with reproduction of HIV-positive couples, such as: (1) Self-insemination, and (2) timed intercourse. Assisted fertility options should be integrated into HIV counseling. (See: Thornton AC, Romanelli F, Collins JD (2004) “Reproduction Decision Making for Couples Affected by HIV: A Review of the Literature” Top HIV Med 12(2):64)
Funding
- France has reportedly pledged to contribute 300 million euros in 2007 to the Global Fund.
- In 2004, the total need for condoms worldwide was 15 billion. Donors provided 2.4 billion, according to Population Action International.