By Rose Wilcher, FHI 360 Technical Advisor in the Global Health, Population and Nutrition Group
The XIX International AIDS Conference, taking place July 22-27, arrives just days after another major global health event, the London Summit on Family Planning. HIV and family planning are both urgent global health priorities — and they are inextricably linked. Prevention of unintended pregnancies among women living with HIV is widely endorsed as an important strategy for preventing vertical transmission of HIV and keeping mothers alive and healthy. Moreover, like all women, women living with HIV have a right to determine the timing and spacing of their pregnancies. The most recent field guidance to implementers from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) deems family planning an essential component of HIV preventive care and urges linkages between the two service delivery areas.
But what does it mean to translate this policy support into practice? Where are linkages between family planning and HIV programs being made in an intentional and substantial way and what can we learn from that experience?
A couple of months ago, I traveled to Zambia to learn how family planning and HIV services are being integrated under a large-scale HIV program — FHI 360’s Zambia Prevention, Care and Treatment Partnership (ZPCT) II. ZPCT II is a five-year (2009–2014) PEPFAR-funded task order contract with the U.S. Agency for International Development to strengthen and expand HIV clinical and prevention services in six provinces. The ZPCT II project recognizes that family planning is an important HIV prevention strategy, particularly in Zambia where the HIV prevalence and the unmet need for family planning are both high (14.3 percent and 27 percent, respectively).
ZPCT II implements a referral-based model of family planning/HIV integration. At most of the 380 health facilities it supports, family planning counseling is integrated into HIV counseling and testing (CT), prevention of mother-to-child transmission (PMTCT) and antiretroviral treatment (ART) services. Referrals are provided to the family planning provider on site for women who desire a method. Within PMTCT services, family planning counseling is provided at all visits, from antenatal care to postnatal care, and women are encouraged to obtain a method at the 6-week postnatal visit.
Notably, family planning is not a stand-alone intervention strategy added peripherally to the main project. Instead, the family planning activities are incorporated into the core project interventions that support HIV service delivery — training of providers, task shifting, supportive supervision and mentorship, quality assurance/quality improvement tools, community mobilization and routine measurement and evaluation. Having family planning within this set of connected, mutually reinforcing project elements serves to institutionalize it as an essential program component and enhances the likelihood that family planning/HIV integration will be sustained over time.
Program data are encouraging. The average number of clients referred from ZPCT II-supported CT and ART services to family planning each month is 2,500 and 250, respectively.
ZPCT II offers just one example of how family planning can be integrated into a large-scale PEPFAR-funded HIV prevention, care and treatment project. PEPFAR implementers everywhere have unprecedented opportunities to accelerate progress toward HIV prevention goals, improve maternal and infant health, and advance women’s rights by addressing the contraceptive needs of clients they serve. Making reproductive rights and family planning part of the conversation at AIDS 2012 will help bring HIV programs closer to fulfilling the promise they hold for providing more holistic, integrated care for women, couples and families affected by HIV.
To learn more about FP/HIV integration under ZPCT II, please access the full technical brief here.
PHOTO: © 2009 Arturo Sanabria, Courtesy of Photoshare.
The photographs in this material are used for illustrative purposes only; they do not imply any particular health status, attitudes, behaviors, or actions on the part of any person who appears in the photographs.