Day 18 Digest (May 24, 2006)
In today’s posting, we have a response from Dr. Young Mi Kim and two comments:
- Victoria Masuku of PSI in Swaziland describes her own experiences as a VCT counselor
- Li Dongli of the China Population and Development Research Center describes research done in China on stigma and how services are being integrated.
Please share your own thoughts and experiences related to the issues raised here and in previous postings.
To participate in the discussion, you can:
- 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 continuing these discussions even after the official end of the forum on Friday. Thanks to everyone for participating and for sharing your questions, concerns, and experiences!
Best regards,
HCP and INFO Teams
Young Mi Kim - Responses to Dr. Stranix-Chibanda, Arzum Ciloglu and Marian Amoa
Dear Dr. Stranix-Chibanda
Thank you for your interest in joining the FP/HIV CPI R&E discussion group. Please send me (ykim@jhuccp.org) your e-mail address. When the group starts, you will receive an e-mail from me.
You may be interested in reviewing the inventory of FP/HIV research which lists on-going or completed studies. It is on the home page of the FP/HIV integration ( http://www.fpandhiv.org). In the middle of the third column, you will find a sub title “Family Planning and HIV/AIDS Integration Partners Working Group Updates”. Under that sub title, you will see FP/HIV Research Inventory (Jan 2006). You can click on it and download the document. Several studies regarding FP integration with PMTCP/ART in Kenya, Zambia, Uganda, Swaziland, South Africa, Zimbabwe and Ghana are listed. A short description of each study and contact person information are included in the inventory.
There will also be a face-to-face forum for researchers to share findings on “linking RH/FP with HIV/AIDS programs in Africa” in Addis Ababa, Oct 9 – 10, 2006. You can find more information about the meeting on the web (www.jhsph.edu/gatesinstitutes) or e-mail Heather Bradley (hbradley@jhsph.edu ). She announced the meeting on this forum and plans to announce it once again later this week.
We’d like to hear your integrated services which are about to begin in Chitungwiza. Best wishes, - Young Mi
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Dear Arzum and forum participants
What a wonderful suggestion from Arzum for us try to get more participation of service providers in the forum. Any other suggestions are welcome!! If you are a service provider or if you can be a intermediary for a provider, please let us hear from you. - Young Mi
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Dear Marian
I am very happy to know that you find the forum very interesting and insightful. I also found that so. Thanks for sharing the information about the documentary – HIV positive voices. Thanks for bringing up a sensitive and important topic to providers as well as clients – balancing between individual right and social responsibility. Values clarification is often a part of the counseling training curriculum, but probably not enough. - Young Mi
Victoria Masuku - Swaziland
Dear Forum Partners,
I have been following the discussions on the need to integrate FP/PMTCT and HIV testing. I am really excited about the idea. I have been a VCT counselor and have had clients share that even though they are positive, they need advise on how they can safely have children. We have the challenge to support them in making informed decisions. On the other hand I have had clients say they would not want to have children, but on further inquiry on a FP method they are using they say none. We have tried to work hard to improve referral systems in Swaziland, but we have been unsuccessful in building a culture of sensitivity and confidentiality with service providers. This remains a challenge when you have to refer the clients post test to a provider who has not been equipped with skills to deal with HIV positive clients.
A lot has been said about the need to train providers, which I agree to, but again a question that has been asked by many: how are we going to deal with human resource constraints and the very high attrition rate of health workers? I do not have the answer to that. But to sum it all we need to integrate FP to VCT services or vice versa to increase the number of HIV positive people who make informed choices on whether to have children or not.
As a way forward, I agree that the providers have to be involved in designing strategies to best integrate the service. We can learn a thing or two from countries that have introduced the concept and adapt best practices.
To share a bit about Swaziland: as you all might know we have a high prevalence rate, We have been successful in reviewing National Policies and Strategies, and this issue was looked at very critically. As a result the current draft guidelines call for integration of HIV testing to FP units. This will for sure reduce our cost per client, but we should have a care of carers' package to motivate the providers by taking care of burnout. The issue of integrating FP services to existing VCT sites has the challenge, since most counselors are lay and not equipped with reproductive health issues. There might be a need to review reproductive health policies to allow lay counselors to be trained on FP.
Lastly policies are good, but they can be abused, or if the recipients of the services are not aware of the policies, or even left out of decision making: then those policies are definitely as good as none existent. What I am trying to say is let the voice of the PLWHA's be heard, since they have the power to lobby to their members for utilization of these services. Dual protection for one has not been well marketed; communication has to be a package of the integration strategy.
Lastly: thank you very much for initiating such a forum, we will continue to have discussions with providers in country, and possibly share their views in this issue.
I am a State Registered Nurse by profession holding a Bachelors degree in nursing sciences. I am currently working as a VCT/HTC (HIV Counseling and Testing project manager for PSI (Population Service International) Swaziland.
Warm Regards,
Victoria Masuku
PSI New Start Network Manager
P.O.Box 4743
Manzini
Mobile 09268 6065903
Tel line 5185913/5187281
Li Dongli - China
Dear Colleagues,
Let me begin by saying my regret for such a delay to join in this 4 week on line forum discussion on integrating FP/and HIV/AIDS, owing to some very urgent jobs I had to complete in past weeks.
I would be very pleased to talk about some situations in China. I am Li Dongli, Ph. D., a research fellow in China Population and Development Research Center, My major fields are: gender , HIV/AIDS and public health. I conducted survey in detoxicating centers and field survey in Henan village. I also employed by UNFPA/UNAIDS/NIDI as national consultant to conduct a survey in 2004.
I would like to share my personal experience in Shangtang Village, Lu Gang Township, Shangcai County in Henan Province, where I conducted a field suvery in the period of October - December, 2004. It is a village with 250 hiv positive villagers, most of who infected HIV through blood donation in early 90s and a few of them through sex transmition between couples. There were 5 children infected through their mother in this village. 50 persons had died of AIDS at the time of surveying. I personally worked together with local family planning workers among children bearing age women. Then, I wrote notes of direct observations to record the situation. I also interviewed individual infected women about their personal life stories on various pains and stigma they had suffered. Apart from the survey in the village, I interviewed officials at all authoritive levels of the government cross sections(focused on family planning and public health management sections) at province level, county level, township level, and village level about the role family planning system played and its effect on the people.
Rich evidence was gathered through this survey. It found that in Henan, HIV/AIDS services provided by local family planning workers were very efficient and welcomed by clients. Informants told me that owing to very strong prevention communication moverment, HIV related stigma was greatly weakened among villagers after they got to know the real reasons for infection. While up to the date among majority population in China stigma is still very strong. This view is also agreed by Dr. Liu Hongyan, my colleague in China Population and Development Research Center and also an expert working in AIDS / family Planning/reproductive health field, and Dr. Yu Wei, another colleague of mine, a family planning program managers at province level.
Integrating HIV/AIDS into family planning is a theme we have advocated for many years. Now, it has been formally stipulated by the document of The State Council issued in Februry 2006, "Regulations of HIV/AIDS work in China". "family planning workers are responsible in providing AIDS prevention services to their clients". Now, "AIDS services are not regarded as something additional, but our rountine jobs", according to Dr. Yu Wei, the Chief of Science and Technology, Poplation and Family Planning Commission, Henan Province(NPFPC, 2006).
According to another survey recently conducted by my colleages Dr. Liu Hongyan and Dr. Yu Wei and others, presently the HIV/AIDS service items provided by family planning system at most grassroots level in Henan Province include: 1, prevention education targeting the general population; 2, condom promotion and distribution; 3, VCT capacity building; 4, comprehensive treatment and care combined with STDs/reproductive tract infection services; 4, Mother to children infection prevention; 5, care the infected and affected; 6, targeted prevention towards migration workers(NPFPC, 2006). 1-4 items are now carried out by family planning system all around China, while items 5 and 6 so far only piloted by family planning workers in Henan.
Comments and questions from colleagues of the world are sincerely welcomed.
Very best regards,
Li Dongli Ph. D.
China Population and Development Research Center p. o. box 2444,
Beijing, China 100081 Tel. 86-10-62172437
86-10-62570716
fax: 86-10-62172101
email: lidongli@readchina.com
Reference: Department of International Cooperation, National Population and Family Planning Commission, "Integrating HIV/AIDS prevention into FP: A survey in Henan". April, 2006