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Reproductive Health into HIV Care Integration

Reproductive Health into HIV Care Integration. Diane Cooper Women’s Health Research Unit, School of Public Health & Family Medicine, UCT. Background and Significance. South African women experience high rates of unintended pregnancy despite the availability and use of

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Reproductive Health into HIV Care Integration

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  1. Reproductive Health into HIV Care Integration Diane Cooper Women’s Health Research Unit, School of Public Health & Family Medicine, UCT

  2. Background and Significance • South African women experience high rates of unintended pregnancy despite the availability and use of family planning services • -In 2002, 53% of pregnancies were unplanned (36%) or unwanted • (17%), even though 64% of sexually active 15-49 year-old SA • women currently use contraception. (NDOH, 2007) • South Africa has one of the highest rates of HIV infection in the world -29.3% prevalence among pregnant women attending antenatal clinics in 2008 (NDOH, 2009)

  3. Background & Significance(contin) • Relatively little is known about the impact of an HIV diagnosis on contraceptive practices and fertility intentions of HIV+ men and women in developing countries • 11% of women attending HIV Care in Cape Town had been pregnant since knowing dx, and 2/3 pregnancies were unintended (Cooper et al 2009) • Nearly 50% of recently diagnosed HIV+ women and men who enter the HIV care system are seeking or are open to the possibility of having children; this was confirmed in larger study (Cooper et al. 2009)

  4. Linkages between SRH and HIV HIV+ conception and fertility intentions (Source: WHO 2005)

  5. Why integration? • Health service integration involves some form of combining interdependent health programs or service elements • Integration can occur both at the level of direct service provision to clients as well as at the level of the structure of management and organisational support of services • By providing joint services, integration hopes : • to avoid duplication of program structures and services • maximize use of scarce resources • Allow greater program cost efficiency &effectiveness • allowing clients greater convenience of being able to receive a range of services simultaneously - promotes better client access to health services, with potentially positive consequences for client health

  6. Integration of HIV & other services • Sexually transmitted infection services • Contraceptive services • TB • SRH into HIV care & treatment

  7. Integration of SRH into HIV care & treatment • Most people living with HIV (PLWH) are in the reproductive & productive years • Important to: • Prevent unintended pregnancies • Prevent horizontal (to partners) & vertical (to infant) transmission • Ensure safer conception & pregnancy

  8. Overview of intervention study integrating SRH into HIV care • 4.5-year, multi-level structural intervention targeting HIV+ persons accessing public sector HIV Care Clinics in Cape Town, South Africa • Addresses poor access to contraceptive services and at same time introduces enhanced counseling approaches that maximize sexual risk-reduction based on clients’ individual situations • Combines quantitative and qualitative methodologies to address both clinic- and client-level factors • Consists of three phases NIMH R01 MH078770-01

  9. Enhanced Intervention vs. Standard of Care ENHANCED On site non-barrier contraception available from HIV care nurses On-site free male and female condoms SRH training, counseling and contraception Posters of HIV+ persons’ reproductive rights in waiting rooms/IEC Systematic, ongoing technical support STANDARD OF CARE • No non-barrier contraception available • On-site free male & female condoms • No specific SRH training, counseling & contraception • No systematic IEC promotion • No systematic, ongoing technical support

  10. Components of SRH-HIV integration Preventing pregnancy • Methods available & dual method or dual protection • Methods best for WLWH – ARV treatment • Emergency contraception (‘morning after pill’) • Termination of pregnancy • Involvement of men

  11. Safer conception

  12. Other SRH needs • Sexual desire & functioning: women & men • Erectile dysfunction & ageing: men • Women: Cancer of the cervix & ageing: women • STI & cross infection of HIV strains

  13. Young people living with HIV (1) • Growing concern - high number of HIV infected young people, in particular young women • HIV cases among the young people - those were vertically infected (VIY), whose life expectancy has been increased through use of HAART) & those behaviourally infected (BIY) • Behavioural infections among the youth account for large portion of new infections globally (45% of new HIV infections world wide in 2007 among young people 15-24 years) • In S.A in particular, estimated that 38% of school learners have had sexual intercourse • Of those that have begun sexual activity 13% initiated sexual activity before the age of 14

  14. Young people living with HIV (2) • Early age sexual debut - youth at > risk for HIV/AIDS & unintended pregnancies, other STIs & forces them to deal with SRH needs & rights at early age • Adolescence: period of rapid change -children become adults & r ability to negotiate numerous physiological & social transitions smoothly largely dependant on health • With changes in sexual activity young people often lack confidence & knowledge to assert reproductive needs & rights • In countries with a high HIV prevalence - need to improve quality of SRH services available to the young people is urgent • In many settings current SRH services offered do not adequately meet needs of young people

  15. Proposed Study among young people living with HIV • Understanding SRH needs of young people living with HIV in particular - critical to ensure health services adequately resourced & programs appropriately designed to meet diverse, common & specific needs • Without this knowledge - difficult to advocate for program devt addressing SRH needs of young people living with HIV during critical stage of development & change in their lives • Study will provide unique information on SRH needs of both vertically and behaviourally infected HIV positive youth in Cape Town. • This formative research will be small collaborative project providing information on SRH needs of HIV positive youth -will be used to guide further counselling interventions - funding being sought

  16. Agenda & needs: integrating SRH into HIV care: • Assessment of SRH needs of WLWH & MLWH • Provide knowledge of SRH for women living with HIV (WLWH) and men (MLWH) – esp. how fertility works • Preventing conception in people living with HIV (PLWH): Contraception • Safer conception and PMTCT for PLWH • Other SRH needs • SRH needs of young people living with HIV These models & agenda can be used in business sector too

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