Day 3 Introduction (May 3, 2006)
Welcome to Day 3 of the online forum on “Client and Provider Perspectives on Integration of Family Planning Counseling and HIV/AIDS Services”. In today’s posting, Ms. Betty Farrell discusses “dual protection” counseling and Dr. Young Mi Kim discusses providers’ and clients’ views on “dual protection” and the issues associated with it.
Ms. Betty Farrell is a Medical Associate for Integration with Engenderhealth/ACQUIRE Project. She has over 20 years experience in development and public health. Her responsibilities with the ACQUIRE Project include developing strategies for strengthening family planning in existing components of reproductive health services and developing new models for integrating family planning with HIV services. Ms. Farrell holds a Master of Science in Nursing (MSN) and a Master of Public Health (MPH), both from Columbia University.
Dr. Young Mi Kim is Senior Advisor for Research and Evaluation at JHU/CCP and Senior Faculty Associate at the Johns Hopkins School of Public Health. She has worked over 15 years at CCP as an expert in quality of care and health communication research in developing countries such as Zimbabwe, Kenya, Tanzania, Nigeria, Ghana, Gambia, Ethiopia, Mexico, Peru, Bolivia, Cambodia and Indonesia. Dr. Kim is well renowned for her contribution to methodological advances in studying interpersonal communication between client and provider. She has over 15 articles published as a principle author in peer-reviewed journals, such as Health Communication, International Family Planning Perspectives. Her studies cover a very diverse client population, such as youth, couples, men and women in diverse service areas such as family planning, HIV/AIDS, general medicine
Throughout the week, feel free to send questions or comments to Ms. Farrell and Dr. Kim, 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 that you can simply click "reply" to this e-mail and post your comment, or log into the forum with the username and password you received.
We look forward to rich and interesting discussions for the rest of the week. Thanks for participating!
Best regards,
HCP and INFO Teams
Dual Protection*
Ms. Betty Farrell, Engenderhealth/ACQUIRE
Dual protection can be defined as a strategy for preventing transmission of HIV, other STIS, and unintended pregnancy, through
i. The use of condoms alone,
ii. The use of condoms combined with other methods (“dual method use”), or
iii. The avoidance of unsafe sex.
“Dual protection” should be a component of prevention counseling. “Dual protection” counseling upholds the concept of informed decision making by ensuring that clients are knowledgeable about and aware of their risks for HIV, other STIs, and unintended pregnancy while making family planning decisions or while making decision related to their sexual behaviors.
“Dual protection” counseling follows basic core counseling principles and can be a part of both individual and couple counseling. Trained counselors and providers help clients simultaneously perceive their risks both of infection and pregnancy and take appropriate actions to reduce these risks.
“Dual protection” counseling also provides women an opportunity to address condom use with their partners for preventing pregnancy, as opposed to preventing HIV and STIs. This is a particularly important risk-reduction strategy for women who are at increased risk of gender-based violence.
*Resource: HIV Prevention in Maternal Health Services: Training Guide and Programming Guide, Engenderhealth, UNFPA, 2004 [website].
Dual Protection
Young Mi Kim, Health Communication Partnership (HCP)
Most FP/HIV integration programs usually adopt the "dual protection" strategy framework. Dual protection is generally defined as prevention from both unintended pregnancy and STIs/HIV. Dr. Jim Shelton* notes four approaches to “dual protection”:
1. Correct and consistent condom use
2. Mutual monogamy and another method of contraception (among seroconcordant)
3. Abstinence
4. Condoms plus another method of contraception (also considered a form of dual method)
A recommended reading on this topic is the paper on Dual Protection (from a Gender Perspective). **
Moving from program strategy to practice, service providers in HIV care settings commonly define “dual protection” as "condom use" because condoms can prevent both HIV transmission and unwanted pregnancy. Providers tend to question the need to talk about "dual method use," that is, the use of condoms with another FP method (one of the approaches to dual protection listed above). They hold the view that condoms can be highly effective if used correctly and consistently. However, providers also know that, because of the difficulty of using a condom with each act of sexual intercourse, their use can lead to unwanted pregnancy. Consistent use is more dependent on the behavior of men than that of women.
Couple communication and negotiation of condom use are critical elements for its success. An HIV positive woman client who does not want to become pregnant may know how unlikely it would be for her husband or partner to use condoms correctly and consistently, but she may not have the courage to contradict the provider (or articulate her views) when the provider recommends the use of condoms. This may eventually lead to an unwanted pregnancy. Providers in HIV care settings would be happy to help clients meet their family planning needs if they knew how and felt confident in doing so. Clients could make better informed choices if they had a better understanding of their options and took part in the decision-making process.
* Personal e-mail communication from Dr. Jim Shelton, 03/02/06
** Prepared by Jeff Spieler for the USAID Inter-Agency Gender Working Group, Subcommittee on Men and Reproductive Health, 06/01/01
Discussion point –
1. How can providers and clients in HIV care settings arrive at informed decisions that meet clients’ FP needs?
2. What has worked so far, and what will work in the future?