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Resources for HIV/AIDS & Sexual and Reproductive Health Integration

Day 15 Digest (May 19, 2006)

Today’s digest includes:

To participate in the discussion, you can:
- click reply to this e-mail
- send your comment to fphivintegration@ibp.wa-research.ch 
- log into the forum website at http://my.ibpinitiative.org/Community.aspx?c=d1f835b2-0c72-420a-9ade-88186b49abe7  with the username and password you received.

ONLINE ARCHIVE

Postings are also archived at http://www.fpandhiv.org/videoconference/cpieventpage.php  along with all the resources mentioned in previous postings. You do not need to know your username and password to read the postings on the web site. While you are there, please take a look at the web site as well. It was developed to bring together in one place all the relevant resources on integration of family planning and HIV/AIDS prevention and services.


We look forward to more of these rich and interesting discussions. Thanks to everyone for participating and for sharing your questions, concerns, and experiences!

Best regards,

HCP and INFO Teams

 

Anne Ntombela – Response to Asfawesen G/Yohannes

Dear Asfawesen,

Thanks for your comments.

 

I do agree with you that the big challenge that we are facing today in Africa is the huge shortage of skilled Human resource and also lack of financial backing.

 

But I still strongly maintain that it is necessary for the today's provider to be able to “kill two birds with one stone", especially when providing HIV and SRH counselling. We can not afford not to be multi-skilled at this stage.

 

It is not easy, but it is possible.

 

These are some possible suggestions:

 

All service providers acquiring the counseling skills and relevant knowledge: I would challenge more HIV and AIDS service providers to include this form of counselling into their services. From CBO level and on, this would start to build the knowledge of a client, making it easy for them to identify a Sexual or reproductive problem they have. Unfortunately most providers expect this to happen only at the health care services level only.

 

We need to spread the burden beyond the health service facilities yet not compromise on quality of the services provided.

Workshops with health workers:

In general, this form of counseling has to be done at all levels, in out and outside structured institutions.

 

I earlier had commented on the referral systems where clients are sent from one place to another (especially with pap-smears) in public hospitals. This consumes time and allows the patient the time to back out of the process. A doctor should be able to counsel a client and do Pap smear at the same time (not refer the patients somewhere else).

 

I believe that there is an urgent need to increase skilled working force to cope with the work load.
But at present when we are advocating for these changes, let’s expand our skill to ensure that we give our clients quality services.

 

I always believe that "we can not put a price on human life"-lets challenge the existing systems (governments, funders etc) to support any programmes that can make a difference in this pandemic stage.

 

In this case QUALITY COUNSELLING.

Thanks and warm regards.

Anne

 

Anne Ntombela – Response to Abebe Shibru - Ethiopia

 

Dear Abebe,

Thanks for your kind comments. I am happy to hear that you are running a wonderful programme in Ethiopia. If my experiences can make a difference in motivating the women in your country, feel free to translate them to Amharic. Do not hesitate to communicate if you need more info.

Warm regards,

Anne

 

Margaret Butau – on training service providers in counseling

To Peggy D'Adamo

Re: Experience in training service providers in counselling for PMTCT.

During the practical sessions one could clearly observe the prescriptive way on the service provider side. The main reason is that it is an easy and fast way to deal with long ques in a given time period. The shortage of manpower in health facilities has resulted in service providers developing coping mechanisms. However, at the end of training the participants had gained confidence and pledged commitment to facilitate the clients to make informed decisions, to share information during counselling and not to educate.

It was noted throughout the trainings held, that more hours were needed for practical demonstration and practice than for theory. The trainers should as much as possible have knowledge of the participants and acknowledge the environment they work in. As a trainer one needs to be alert and sensitive to the reaction of the participants when sharing experiences because some may easily break down. HIV and AIDS are affecting almost everyone in one way or the other and counselling sessions can bring back painful memories.

Margaret Butau

David Rivett -  WHO Ukraine

 

I greatly appreciate Peggy D'Adamo’s raising the point concerning the abilities of service providers in providing appropriate and quality services, as it gives me the opportunity of raising the issue of HIV services for young people.

 

I am working in the WHO Country Office in Ukraine as the Technical Officer for Young People’s and Adolescent Health, and in collaboration with many agencies and government ministries, the age group we are jointly addressing is the 10-24 year olds, with an emphasis on 15-24.  Marriage and long term relationships are common at this age, as, unfortunately, is the greater incidence of IDU, and sex working. I think the public health argument is clearly made that the needs of young people in terms of health deserve special attention, especially as in Ukraine the under 30 age group is currently the most affected by HIV.  We are working to build the capacity of service providers in developing family planning, counseling and HIV services that are more appropriate for the age group through the introduction of the notion of Youth Friendly Services.  WHO has developed a modular programme for orienting services providers to work more effectively with this age group.  The Orientation Programme on Adolescent Health for Health Service Providers is modular and includes core and optional modules on the following topics:

CORE MODULES
A. Introduction

B. Meaning of Adolescence and Its Implications for Public Health

C. Adolescent Sexual and Reproductive Health and to include sexual orientation and other aspects of sexuality and informed choice

D. Adolescent Friendly Health Services

E. Adolescent Development (under development)

F. Concluding (Reflects on improving work for/with young people)

G. STIs J. Pregnancy Prevention

K. Substance Use (under development)

N. HIV/AIDS (under development)

Q. Injuries, violence (under development)

R. Communication and Counselling – to be developed at European regional level, based upon WHO Counselling Guide

X. IDU OPTIONAL MODULES

H. Care of Adolescent Pregnancy

I. Unsafe Abortion L. Mental Health (under development)

M. Nutrition (under development)

O. Chronic Diseases (under development)

P. Endemic Diseases (under development)

In Ukraine, many services for this age 15-24 age group are found in different places, due to the health services structure left over from soviet times, based upon primary care delivered through poly clinics for those under 18,  poly clinics, family planning centers, narcology clinics and other specialized centres and clinics for adults (those over 18).  In this set up there is a need to orient both pediatricians and service providers for adults, including family planning services, to better ways of working with this age group.   VCT is usually provided in separate AIDS Centres as well as through NGOs (pre and post counseling only) and again, there is an urgent need to address the attitudes and practices of these service providers to the needs of young people.    The Orientation Programme is one way in which we hope to build understanding and skills in service providers for young people.

It would be nice to see some further comments on this discussion related to the needs of young people and adolescents.

 

Caroline Tran – USA

 First of all, thank you very much to the organizers of this e-forum. The discussions have been extremely interesting and helpful.

In response to Abebe Shibru’s submission, I would like to request more information on the mother to mother support program in Ethiopia. I am currently examining approaches to FP-HIV integration at the community-level, particularly for PMTCT settings. This mother to mother support program sounds very unique and promising. I would be very interested in learning further details on how the support groups are created and how the mothers are provided family planning and HIV/AIDS information. How do the mothers share this information with one another and support each other? Through informal or formal gatherings? Do they refer each other to receive FP or PMTCT services?

In addition, I would welcome input from others in the forum of other successful examples of community-based FP-HIV integration activities focusing on PMTCT. Thus far, the discussions have mainly focused on facility-based integration programs; however, I would like to know what others have experienced in terms of integrating FP and HIV at the community level, utilizing community-based workers and members.

Thanks and best regards,

Caroline Tran
Program Officer
Extending Service Delivery (ESD) Project
1201 Connecticut Avenue, NW
Suite 500/501
Washington, DC 20036
Tel: (202) 775-1977 Ext. 228
Fax: (202) 775-1988
ctran@esdproj.org

 


Summary of May 18 USAID FP and HIV/AIDS Integration Working Group Meeting

The focus of the meeting was “FP/HIV and Youth, and Other Hot Topics.”  It began with a brief welcome from Jeff Spieler of USAID and Carolyn Baek of Population Council. John Townsend of Population Council gave a history of the group and explained the purpose and structure of the two-day meeting. 

 

History:  The working group was established in the fall of 2004 by USAID to provide a venue for sharing information and research and fostering collaboration.  The group has a rotating chair. Family Health International was the first chair, followed by Population Council, to be followed by Futures.  The group meets twice each year and each meeting has had a particular focus.  The first meeting focused on FP and PMTCT, FP and VCT and FP and care and treatment. The second meeting focused on how to operationalize integration, moving from research to action and included updates on field activities and biomedical research. The third meeting focused on FP and ARVs and included presentations by HIV+ women and colleagues reporting from the field.

 

Ann Biddlecom of Guttmacher Institute started off the day with a presentation on “Adolescents’ Views of Pregnancy and HIV Prevention: New Evidence from Burkina Faso, Ghana, Malawi and Uganda.”  She reported on the results of the 2004 National Survey of Adolescents, which was a household-based survey of 12-19 year olds in those countries.  She reported that their awareness of HIV and contraceptive methods was high but knowledge of STIs was lower.  Practical knowledge about HIV and contraception was low and misperceptions abounded.  The young people reported many sources of information on contraception, HIV and STIs – family, friends, teacher/school, health provider and the mass media. Mass media was the most popular source of information.  Her key findings included:

Awareness of family planning and HIV is high, practical knowledge is low; misperceptions abound There is a low level of awareness of STIs apart from HIV Adolescents rely on multiple information sources Sex education classes or talks in school are not widespread There are large gaps between needs of sexuall-active adolescents and service utilization Clinics or hospitals are the most commonly known and preferred source for FP, HIV and STI services Many young people do not know of any source for these services Social reasons (embarrassment, fear) are the most common barriers to service
 

In addition the first day also included presentations on youth friendly services in Kenya from Dr. Joachim Osur of Family Health Options Kenya (one of our week two experts); standards-driven national quality improvement in Tanzania by Peter Weis of WHO a new project with the aim of reaching married adolescents with HIV information and services in Kenya by Ian Askew of Population Council how to assess the sexual risks and reproductive health needs of orphans and vulnerable children in Zimbabwe by Barbara Janowitz from Family Health International more research with young people in Tanzania (focus groups) on what the ‘be faithful’ message means to them in the context of pregnancy prevention and HIV, presented by Joy Noel Baumbartner of Family Health International.
 

There were also presentations on new tools and reports and updates on past events as well as discussion of activities related to FP and HIV/AIDS integration that will take place during the Toronto AIDS conference in August. 

 

We will be sure to share additional information about the meeting and resources with you next week.

Please send any comments about the Resources for HIV/AIDS and Sexual and Reproductive Health Integration site to info@hivandsrh.org.