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Resources for HIV/AIDS & Sexual and Reproductive Health Integration

Day 12 Digest (May 16, 2006)

In today’s posting, we have four comments and some resources from UNFPA on integration:

Please share your thoughts about the issues raised here and in previous postings with us.


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 continued rich and interesting discussions. Thanks to everyone for participating and for sharing your questions, concerns, and experiences!

Best regards,
HCP and INFO Teams

Konjit Kifetew - Ethiopia

Dear forum participants,

I read Anne Namwamba-Ntombela's posting, which is empowered and inspiring for other women, and reflects the reality that what the clients want and the providers do not always go together.

As a client, we want full information and we do not want the provider to decide for us whether as a positive women we can have a child or not, or to be tested or not when we come for prenatal services.

However which is happening is the provider decides, if a woman is pregnant to test he and if she is positive to lecture her not to have a child. I feel in our context, for the client in order to ask for information, the client need to know the existing available services, the role of the providers as well as the sexual reproductive health rights. Without adequate information a client is not empowered.

So one important issue is awareness and education of women and men on FP and HIV/AIDS and the services and their rights. The clients need to be empowered, how through information on the services on the FP and the rights of clients.

Women should be educated to ask for full access to information of FP/PMTCT/HIV/AIDS and where the services are available, and we as clients then can decide whether to have a baby or not or to get tested, the information help us to decide.

The training of service providers on the reproductive health rights of the clients and providing information for clients on the available services technologies of contraceptive, ARV and PMTCT will facilitate the integration of FP with HIV/AIDS and of course protecting the rights of clients.

Regards
Konjit Kifetew -Ethiopia

Chris Aynamene - Nigeria

Anne's submission highlights again the issue of provider driven stigma and discrimination and gender bias. Many providers act from a perceived height of superiority instead of been driven by service provision. Females are still generally looked down upon in our African societies and this controls the psyche of service providers. The negative effect is that clients enter a shell and may never go back to the centre. The end point is that sustained education and enlightenment should be embarked upon at the general population level and providers and clients level. Emphasis at the general level is that we are all equals and should be treated alike no matter our situations while at specialised levels the issues pertaining to family planning, HIV and AIDS and other health situations could be handled.

Thank you.
Chris Anyamene
President - Development Initiative and Processes
Awka, Nigeria


Maria de Bruyn

Thank you, Anne, for pointing out these issues of importance from the client's and counselor's perspective. Your comments show that HIV/AIDS and SRH programs and training of counselors and providers ideally need to incorporate several points/topics:

  1. Voluntary testing and counseling must be made more easily accessible and acceptable to women outside the antenatal care setting.

  2. Women living with HIV/AIDS must be able to exercise the same sexual and reproductive rights as all other women, including the rights to information, privacy and confidentiality, and informed consent. This means that HIV-positive women also need to know how discriminatory practices in the health-care setting can be addressed. For example, hospital ethics committees, NGOs, human rights commissions and ombudspeople should help devise procedures whereby cases of discrimination and violations of rights can be reported (if necessary
    anonymously in case a woman is afraid that a complaint might jeopardize her future care). This is especially needed in cases involving pressure to be sterilized, pressure to have an abortion, and denial of care when a woman presents for delivery or pregnancy termination.

  3. Many counselors and providers are unfamiliar with the concept of sexual and reproductive rights; pre-service and in-service training should include sessions on human rights and how these apply to the sexual and reproductive health of people living with HIV/AIDS, as well as to the conditions under which providers work (i.e., they also have rights, for example, to adequate supplies to undertake universal precautions and to PEP). It is also important to include women living with HIV as paid co-facilitators for such training sessions; Ipas has
    had good experiences with this approach in Vietnam.

  4. Women living with HIV/AIDS need comprehensive counseling regarding pregnancy and childbearing. They need to know which contraceptive methods would be the best choice in their particular situation, the advantages of dual protection, available measures to reduce perinatal transmission of HIV, and also what to do if they do not want to carry an unwanted pregnancy to term. No contraceptive is 100% effective and some women not using contraceptives have unwanted pregnancies as a result of rape; they need to know about emergency
    contraception and the indications under which abortion is permitted by law (in many countries, this includes cases of rape and danger to the woman's health). Many women living with HIV undeniably want to have (more) children; however, HIV-positive women are also among those who have abortions, and they should have access to safe legal procedures.

  5. As more people gain access to ongoing antiretroviral therapy and their survival is considerably prolonged, thought should be given to possibilities of HIV-positive people adopting children in countries where this is an available option.

Maria de Bruyn

Lynda Stranix - on Dr. Jim Shelton's introduction to week #2 - Provider Perspective

I was only able to reply to this today and I have one comment - we should not assume that integrating FP and HIV services creates more work. Prevention efforts may likely result in reduced work in other areas of the clinic through less pregnancy bookings, less out-patient attendances, etc. Motivation should not be financial rewards.

Lynda

UNFPA Resources on Integration

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