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Translating Contraception into Practice in the Era of HIV/AIDS


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Presented on 11/9/2010 by Deputy Director of MEASURE Evaluation, Jason Smith, at the APHA Conference in Denver, Co.

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Translating Contraception into Practice in the Era of HIV/AIDS

  1. 1. Translating Contraception into Practice in the Era of HIV/AIDS Jason B. Smith University of North Carolina at Chapel Hill and Rose Wilcher Family Health International
  2. 2. Presenter Disclosures <ul><li>Jason B. Smith </li></ul><ul><li>I have no conflicts of interest to disclose </li></ul>
  3. 3. Family Planning & Social Justice <ul><li>UN International Conference on Human Rights, Tehran, 1968 </li></ul><ul><li>World Population Conference, Bucharest, 1974 </li></ul><ul><li>Convention on the Elimination of All Forms of Discrimination Against Women, New York, 1979 </li></ul><ul><li>International Conference on Population, Mexico City, 1984 </li></ul><ul><li>International Conference on Population and Development, Cairo, 1994 </li></ul>
  4. 4. Family Planning and the Public Health Imperative
  5. 5. Use of Modern Contraception Worldwide Percent of Married Women 15 to 49 Using Modern Methods Note: More developed regions include Australia, New Zealand, Europe, North America, and Japan. Less developed regions include Africa, Asia (excluding Japan), and Latin America and the Caribbean; the UN designates 49 countries within these regions as least developed. Source: Population Reference Bureau, 2009 World Population Data Sheet . From Population Reference Bureau Graphics Bank 2010
  6. 6. Best Practices in Family Planning <ul><li>WHO Medical Eligibility Criteria and Selected Practice Recommendations </li></ul><ul><li>Cochrane Collaboration Systematic Reviews </li></ul><ul><li>Implementing Best Practices Consortium </li></ul><ul><li>Various Best Practice Compendia (e.g., Advance Africa) </li></ul><ul><li>Kampala Family Planning Conference recommendations (2009) </li></ul>
  7. 7. Taking FP to Scale Now: <ul><li>Improve contraceptive security </li></ul><ul><li>Provide a wider range of methods </li></ul><ul><li>Emphasize long acting methods </li></ul><ul><li>Screen women attending primary care services for family planning need </li></ul><ul><li>Provide counseling and methods immediately post-partum and post-abortion at the service delivery site </li></ul><ul><li>Strengthen communications, outreach and services in the community </li></ul>
  8. 8. Integrating Family Planning and HIV Services
  9. 10. Integrating FP and HIV Services <ul><li>Prevent unintended pregnancies in HIV+ women. </li></ul><ul><ul><li>Reduce spread of HIV through vertical transmission </li></ul></ul><ul><ul><li>Reduce number of orphaned children </li></ul></ul><ul><ul><li>Protect the reproductive rights of HIV+ women </li></ul></ul><ul><li>How? </li></ul><ul><ul><li>Increasing use of both services </li></ul></ul><ul><ul><li>Joint programs can more completely and efficiently meet the public’s needs </li></ul></ul>HIV services Family planning
  10. 11. Integrating FP and HIV Services <ul><li>How to integrate? </li></ul>    Generalized Concentrated
  11. 12. <ul><li>How? </li></ul><ul><li>Train and equip FP workers to perform HIV testing & counseling </li></ul><ul><li>If possible, provide HIV treatment services (ART, PMTCT) </li></ul><ul><li>Provide commodities </li></ul><ul><li>Structural improvements (supervision, M&E, referral) </li></ul><ul><li>Benefits </li></ul><ul><li>Provides opportunities for HIV testing with sexually active women and men </li></ul><ul><li>May increase use of HIV treatment </li></ul><ul><li>Can attract HIV+ clients who would not otherwise seek out FP services </li></ul>HIV services Family planning sites
  12. 13. <ul><li>How? </li></ul><ul><li>Train HIV service providers to counsel & refer on FP methods </li></ul><ul><li>Provide commodities </li></ul><ul><li>Structural Improvements (supervision, M&E, referral) </li></ul><ul><li>Benefits </li></ul><ul><li>Prevent unplanned pregnancies in HIV+ women </li></ul><ul><li>Opportunities to provide men with FP services/information </li></ul><ul><li>Repeat visits = opportunity for resupply and reinforcement </li></ul><ul><li>Less stigma than at FP centers </li></ul>Family planning services HIV service sites
  13. 15. Source:FHI
  14. 16. Infant feeding and HIV: WHO Guidelines Is replacement feeding safe and supported? Is ARV treatment available? Yes No Yes Depends on national guidelines and local conditions Exclusive replacement feeding No Exclusive breastfeeding for 6 months, followed by 6 months of mixed feeding Exclusive breastfeeding for 6 months, followed by 6 months of mixed feeding
  15. 17. Breastfeeding & Family Planning <ul><li>Lactational Amenorrhea Method (LAM) </li></ul><ul><li>Safe methods for breastfeeding women </li></ul><ul><ul><li>Hormonal: Progesterone ONLY </li></ul></ul><ul><ul><li>Non-hormonal </li></ul></ul>
  16. 18. Conclusions Source:USAID
  17. 19. This presentation is based on work done by MEASURE Evaluation and Family Health International with support from the U.S. Agency for International Development (USAID) and the World Health Organization (WHO). Views expressed in this presentation do not necessarily reflect the views of the United States government, USAID or WHO.