Introduction to Week 2 (May 8, 2006)
Welcome to Week 2 of the online forum on “Client and Provider Perspectives on Integration of Family Planning Counseling and HIV/AIDS Services.”
This week we will be focusing on provider perspectives. Our experts for this week are Dr. Joachim Osur from Family Health Options Kenya, Dr. Gina Brown from the New York City Department of Health and Mental Hygiene, and Dr. James Shelton from USAID Washington.
We will start this week with a posting from Dr. Joachim Osur. Dr. Osur works with Family Health Options Kenya (formerly the Family Planning Association of Kenya) and has a degree in Medicine and Surgery (MBChB) and a post graduate qualification in Public Health (MPH). Dr. Osur has wide experience with running SRH programmes in the developing world and has successfully pioneered integrating all aspects of HIV/AIDS care into SRH services.
Throughout the week, feel free to send questions or comments to Dr. Osur, as well as submit your own experiences, findings or lessons learned on the topic of the week. Please refer to the submission instructions and guidelines you received last week on how to post comments/questions for the online forum. Remember there are three ways to respond:
- simply click "reply" to this e-mail and post your comment,
- send your 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.
We look forward to rich and interesting discussions. Thanks for participating!
Best regards,
HCP and INFO Teams
PROVIDER PERSPECTIVES: FP COUNSELING AND HIV/AIDS SERVICES
Introduction
In integrating HIV/AIDS and FP/SRH services, two scenarios are possible: either HIV/AIDS services are introduced into existing FP/SRH services, or FP/SRH services are introduced into existing HIV/AIDS services. Whatever the case, there are benefits and challenges of creating these linkages. Below I give a summary of the perspectives on both strategies based on my experience.
Benefits of the Integrated Service
FP clients have a chance to undergo HIV testing if the set up is an SRH or FP clinic. SRH clinics are very well developed in the developing countries and receive many clients in a year. Integrating HIV/AIDS counseling is the best strategy in increasing testing, promoting prevention and linking those infected to care and support services.
The biggest problem in developing countries is that most people are only referred for HIV testing when they fall sick. By the time their HIV status is discovered, they have been sick for a long time. Some even die before the testing is done. The result of this is high bed occupancy rate in hospitals for HIV related illnesses; and high morbidity and mortality rates relating to HIV/AIDS.
Linking HIV counseling to FP gives clients an opportunity to know their status before they fall sick. Clients going for their usual FP clinics are given a chance to do HIV test. They then get into care programmes on time if the test is positive. This reduces the high morbidity and mortality rates related to HIV/AIDS in the developing world.
Lack of medical staff and inadequate service delivery points (SDPs) is another big problem in the developing world. Linking the two services increases access to both by utilizing the few staff and the few SDPs available.
Integrating FP counseling into existing HIV/AIDS services increases FP uptake. It is a good way of promoting FP. In addition, it is a prevention strategy for reducing mother to child transmission of HIV. It ensures that unplanned pregnancies in PLWHAs are prevented.
Linking FP counseling into existing HIV/AIDS services opens up the whole area of sexual and reproductive health needs of PLWHAs. Currently most HIV/AIDS services do not counsel clients much on this topic and this would be a good starting point.
Challenges of the Integrated Service
Countries must develop policies that support integration. In most countries, planning for FP/SRH is done by different departments of the Ministry of Health or even different ministries of the government. This makes integration of the two services hard at the operational level.
Staff need to be trained adequately in both services. This is expensive. In adequate training can be counter productive to desired outcomes.
Integrating the services means that service providers will take longer than usual with one client. This leads to long waiting hours for clients. In addition, there is a possibility of overworking the service providers unless more are recruited.
Integrating the services also calls for development of more referral networks. In resource poor settings, there may be no referral sites in the vicinity. Hence, integrating the two services will mean offering the full range of services for each of the areas. This is expensive to set up.
Dr. Joachim Osur