1+1=3

1. 1+1=3 FP/HIV Integration Africa SOTA June 2002

2. Purpose of This Session • Review key concepts of new guidance • Reality check-in through small group discussion • Report on what works and doesn’t and provide cameo country examples

3. Definition and Rationale FP into HIV/AIDS HIV/AIDS into FP No missed GOOD opportunities

4. What Has Changed: Field Officer Demand HIV Field Support into POP Projects

5. FY 2001 HIV & POP Core Funding

6. Dual Protection / Integration Estimated Funding by Type 23 Agencies Responding Total USAID Funding = $180,898,167

7. Technical Guidance for USAID Supported Field Programs • Update of the December 1998 Guidance • Brief and focuses on emerging priorities • Evidence base for FP/HIV integration is rapidly growing – guidance will be periodically reviewed and up-dated

8. Guiding Principles • Evidence-based • Synergistic • Programming for Impact • Reaching the tipping point

9. Old school approaches to prevention

10. New approaches to ABCD • Abstain or Delay • Median age of first sex among girls in Uganda increased from 16.5 in 1998 to 17.3 in 2000 • Be-Faithful • 72% of unmarried Uganda women and 65% of men reported having no sexual partners in the past year • Condoms or Contraception Use • A study in Ethiopia found CSWs who were using condoms for contraception more likely to use condoms consistently and less likely to become HIV-infected • Don’t Do Drugs

11. Prevention is Central to Both Programs ABCD behavior change messages should be a priority area for investment. Caveat/Areas for more research: • Gender aspect of ABCD • Mixed messages and socially marketing behavior change • Early marriage: protective against HIV/STI yet makes young women more vulnerable to early pregnancy

12. Dual Protection • Using a condom for prevention of both pregnancy and HIV/STI • Using a condom and another family planning method • Mutual monogamy and another family planning method • Abstinence and delay of sexual debut among adolescents • Avoidance of all forms of penetrative sex

14. Youth • Largest youth generation in history is entering their childbearing years. • Diverse group in need of multi-pronged approaches • The delay of sexual debut in Uganda and Zambia contributed significantly to the decline in HIV transmission among this age cohort. Caveat/Areas for more research: • Reaching youth before sexual debut • Effective community approaches to support behavior change as well as increases age of marriage

15. Policy Policies contribute to changing social norms • Uganda’s approach to “zero grazing” • Need for a supportive policy environment for youth • HIV epidemic’s effect on family planning programs

16. MTCT and FP • The best method to prevent mother to child transmission is the utilization of family planning to prevent unwanted pregnancies. • Prenatal VCT should include counseling about the benefits of birth spacing and information about family planning. • Breast feeding counseling and options should also include information about LAM. Caveat/Areas for more research: • Loss to follow up for women who deliver at home • Addressing unmet need for FP

17. VCT and FP Counseling during VCT sessions should include counseling about family planning. HIV-positive and HIV-negative women should learn about the importance of family planning and its benefit to reduce mother-to-child HIV transmission. Some VCT services should have the capacity to provide limited family planning services,such as condoms, pills and Depo-Provera. Caveat/Areas for more research: • Need to watch burden on provider and how clients who receive contraception or referrals are followed-up • Information is needed to determine if integrating services increases up-take of family planning and/or VCT?

18. STIs are Important But… • Information about STIS prevalence is a wise investment • Syndromic management of vaginal discharge in NOT effective for GC/CT but can identify vaginitis • Metronidazole may provide relief to women with uncomfortable discharge • Syndromic approach is appropriate and effective for ulcers in men and women and urethral discharge in men • Logistics and costs of drugs are a barrier to effective STI programs • Counseling about risk of HIV and unwanted pregnancy and provision of condoms should be part of any STI program intervention

19. Community Based Organizations • Community organizations, including FBOs can play a critical role in changing community norms • CBD programs can successfully integrate HIV prevention information • Family planning information can be integrated into community services related to home-based care

20. Commodities and Logistical Systems • No product, no program • Quality condoms must be available for both family planning and HIV programs • Existing FP commodity procurement may help to address burgeoning needs of HIV programs

21. Promising Areas for the Future • Male Circumcision: linking men to reproductive health care services??? • Utilization of FP infrastructure: a venue for HIV-related service delivery???

22. Next Steps • Finalize Guidance • Develop a format that is user friendly • Dissemination through multiple channels • Ongoing dialogue with the field through virtual members of Working Group

23. Are the technical areas on target? Is there important information missing? How does this resonate with the work you are doing? Do you have country-specific examples? ABCD – dual protection Youth Policy MTCT/FP VCT/FP STIs CBOs Commodities and logistics systems Your input is needed!