Meeting Clients Needs for FP in ART in Uganda Makerere Institute of Social Research POLICY Project, Futures Group Karen

1. Meeting Clients Needs for FP in ART in UgandaMakerere Institute of Social ResearchPOLICY Project, Futures GroupKaren HardeeMarch 1, 2006 Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

2. Methods of Data Collection • Data collection in 2005 • 2 urban / 2 rural sites • Document review - relevant policy documents, surveys and reports • In-depth/semi-structured interviews with Policy Makers, Program Directors, Centre managers, Providers (Counselors) • FGDs/Exit interviews with HIV+ Clients Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

3. FP in ART Policy • Not in 2003 National ART Policy and National Guidelines for Implementation of ART “My mandate doesn’t include FP. We deal with people who are sick. We don’t go to FP.” (Senior Official) “It will also need a change in policy of ART to include FP. There is need to develop a work plan from the Ministry of Health that includes the integration of the two services.” (Counselor, ART) Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

4. Policy Opportunities • Add FP to national ART policy • Add to guidelines/protocols to support FP in ART settings – including provision and referral • ART client assessment form includes FP – related to which ART to use • Monthly FU on FP at ART Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

5. PLHA Interest in FP • Most express desire for integrated HIV/AIDS and FP  • Prefer to receive FP at the same places they receive HIV-related services and from providers who already know much about their personal lives   “Obtaining FP services from here would save us from the embarrassment we face when we go to FP clinics outside” (Female client) Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

6. FP Training for ART Providers • All ART providers trained by TASO • Currently, ART providers take it upon themselves to provide FP counseling.  “On the whole, FP is not in our work. Remember I did not talk about it when you asked me about the services we give to our clients.” (Counselor) Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

7. Providers Acknowledge Need for FP “You see here we get clients who come when they are very weak. After gaining weight and good health due to ART, they become sexually active again, so they come and ask how they can avoid pregnancies. ” (Counselor, ART) Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

8. Provider provision of FP – Dilemma for clients • Providers often urge HIV-positive clients to limit sexual activity to avoid health deterioration    • Many clients misconstrue this to mean that they should not be having sex since they are HIV-positive – so if they ask for FP, they are admitting as much.  Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

9. What Clients are Hearing • Use condoms for dual protection “Counselors told me that if one makes a woman pregnant when she has HIV/AIDS, it is bad because the pregnancy sucks a lot of energy from the woman, as a result she looses strength, she looses weight and produces a sick child and the child may die….This is the main thing they tell me. (Male, Exit Interview) Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya

10. Summary/Recommendations • ART clients are sexually active • ART clients want FP and at the ART center • ART clients are a motivated group regarding childbearing • They need/deserve accurate information on which to make reproductive decisions. • Policy, program and training opportunities exist to integrate FP into ART Accra, Ghana • Baltimore, USA • Geneva, Switzerland • Nairobi, Kenya