Online Discussion Forum
March 6, 2007
Daily Digest #2
Dear forum members:
Today we received a thought provoking contribution from Dr. Richard N. Amenyah from FHI-Ghana on three important topics; 1) common misconceptions about contraception; 2) integrating FP into ART services; and 3) provider training on stigma reduction strategies. Do you have thoughts on client-provider interaction or experiences to share? Email fphivintegration@ibp.wa-research.ch or simply reply to this email.
Scroll down to read Dr. Amenyah’s comments as well as a case study on client-provider interaction. This scenario presents a situation in which an HIV+ woman visits an HIV provider looking for information about family planning. It also demonstrates some of the principles of good client-provider interaction and counseling principles. Please read the case study and respond to the questions. Think about what makes a good counseling experience from the point of view of the client. What are some of the things that you, as a provider, try to remember when counseling your clients? What experiences have you had, as a client, that illustrate good or bad counseling?
Best,
Megan O'Brien
For the IBP Initiative
www.ibpinitiative.org
info@ibpinitiative.org
+++++++++++++++++++++
I wish to congratulate all the presenters so far for sharing their work/experiences with all of us. I must say that I identify with most of the issues raised.
1. In Ghana, most women have misconception about FP in general and their main fear as articulated by clients to me and am sure other providers is 'if you do family planning, you will not be able to give birth again when you need it'. This is a powerful statement which gets most women contemplating to do FP very worried irrespective of whether they are HIV (+) or not. They blame this fear on virtually all forms of FP methods. This misconception is largely perpetuated by the elderly women (mothers/grandmothers) who may no longer be in their reproductive potential and since they mostly educate and support the young and inexperience women on reproductive health matters at home (they have examples to sight of women who have not been able to give birth 'because' they did FP). These women are indeed major stakeholders in addressing this misconception. One way I have been able to deal with this issue is to engage the client and the concerned elderly relative (partner or mother or grandmother) in intense information sharing (counselling) geared towards dispelling the misconceptions. Clients who want to do FP without the knowledge of their partners are also given such a confidential counselling on the benefits of FP.
2. Within the context of HIV care and treatment, my experience of integrating FP into ART services in a district hospital in Ghana has been such that inspite of all the detailed training (HIV counsellors/nurses) on counselling clients appropriately and use of job aids to assist clients to accept any of the methods of their choice and also use dual protection, the providers have little time to deliver the FP services effectively due to limited human resource, which makes service delivery difficult because they are the same key staff who provide the other HIV care and treatment services which are very demanding in themselves. Those who choose dual protection (including condom) were few even though condom only acceptance was relatively much higher.
3. Training on stigma reduction strategies in general (not necessarily relating to FP) are helpful since it de-sensitizes providers alot after they have been taken through vale clarification sessions. This approach was used by FHI in Ghana in 2002 when it undertook the START Program which was a comprehensive HIV prevention, treatment and care program. It engaged providers and client alike on HIV stigma issues and this brought to light how clients experienced stigma and discrimination through the actions and in-actions of providers and this served as a basis for 'desensitizing' providers. Similarly during national PMTCT training, stigma and discrimination issues are raised and linked up to the second prong of PMTCT strategy of preventing MTCT among HIV positive pregnant women.
Thank you.
Dr. Richard N. Amenyah
FHI-Ghana
+++++++++++++++++++++
Case Study
Grace is a provider in the ART clinic. She has worked in the field of HIV for five years. Recently, the clinic director decided to integrate family planning into their existing services. Grace and two of her colleagues were sent to a course on family planning counseling. The clinic is usually very busy and the providers are worried about having enough time to counsel clients on family planning as well as their usual duties.
Dora is a 22 year old woman living with HIV. She has three children, ages 1, 3 and 4. She found out she was infected with HIV during her last pregnancy. Her husband works in a mine and she sees him three times a year. She also has a boyfriend she sees from time to time.
During the counseling session, Grace learns that Dora has never used family planning methods before and has some misconceptions about using them given her HIV status. Grace also learned that neither Dora’s boyfriend nor her husband uses condoms. Based on what she’s heard from Dora, Grace asks if she wants to get pregnant again. Dora says that she has little family support or help caring for her children and she doesn’t want another one in the next few years. Because Dora doesn’t want to get pregnant again anytime soon, Grace only discusses long-term family planning methods. She advises Dora to use DMPA and gives her some condoms to take home.
As Dora leaves the clinic, she has second thoughts and worries about how she will ask her partners to use the condoms. She decides to leave them near the reception desk and goes home.
1. What else could Grace have done for Dora?
2. What were Dora’s responsibilities in this interaction?
3. How is this scenario similar/different from what providers are facing in the field?