Module I: Overview

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Learning Objectives
By the end of this module, the participants should be able to:
Explain the rationale for integration Discuss the importance of FP and safer pregnancy services Explain reasons why HIV clients may consider or may avoid pregnancy Examine own values/attitude about sexuality and childbearing for HIVinfected individuals and couples

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Why Integrate HIV and RH Services?

Clients Seeking HIV-related Services AND Clients Seeking RH Services

Share common needs and concerns:

are often both sexually active and fertile are at risk of HIV infection or might be infected need access to contraceptives need to know how HIV affects contraceptive options
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Goal of Integrated FP/HIV Services

Holistic Care that Meets Clients Needs To provide comprehensive HIV prevention, counselling, testing, and treatment services in which FP is an integral component of care To provide comprehensive FP services in which HIV prevention, counselling, testing, and treatment is an integral component of care

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How Does the CCC Link with Other Services?

Prevention Acceptance of serostatus CCC and its links with other services Provision of maternity services

Planning for the future

Reproductive Health/Family Planning Early diagnosis & access to early medical care

Peer, social, & community support

UNAIDS Technical Update. English original, May 2000.

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Why Integrate FP in HIV Care and Treatment Settings?

Patients may not follow up on referrals to other clinics Staff at FP clinic may not be familiar with special needs of HIV-infected patients Clients benefit from multiple services from one visit through holistic service provision It is convenient for patients as it shortens their waiting time in other service areas It may help overcome stigma related to HIV/AIDS

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Importance of FP and Safer Pregnancy Services

Spacing and Limiting Size of Family Couples where one or both partners has HIV may want to space children and limit the size of their families to the number of children they desire and can care for. Sexual Activity People living with HIV are often sexually active and have the same desire for a sex life as HIV-negative people. Return to Sexual Activity with ARVs Many people living with HIV are getting treatment that improves their health and are returning to sexual activity when receiving ART and becoming pregnant.
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Importance of FP and Safer Pregnancy Services

Pregnancy in Women on ART Rates of pregnancy are high among women on ART. General FP service providers may not be well-informed about the special needs of HIV-affected families. Desire to Avoid Leaving Orphans Women with HIV who are concerned about their premature death may desire contraception to avoid having children who may become orphans.

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Importance of FP and Safer Pregnancy Services

Desire for Children People with HIV may also have a desire for children and have the same rights to reproduction as HIV-negative people. Avoid HIV Transmission to Children HIV-infected women are at risk for transmitting to their infants. Providing prophylactic ARV therapy or treatment decreases this risk substantially. Women with high viral loads are at increased risk of transmitting HIV to the child and should be advised to postpone pregnancy until they respond to treatment. FP services help these women avoid pregnancy until they are ready.

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Reasons Client with HIV May Consider Pregnancy

Fear children they have are already infected and may not survive Concern about reduced fertility related to HIV infection Reassurance that PMTCT reduces risk of having an HIVinfected child Longer life expectancy due to ARV therapy Societal, familial pressures to have children Avoid generating suspicion about status Apprehension about consequences of disclosing status
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Reasons HIV Clients May Avoid Childbearing

Have similar reasons for avoiding/postponing as women without HIV:
Maintain family economic status Achieve desired family size Achieve ideal spacing and timing of children

Fear of transmitting HIV to children Fear of transmitting HIV to ones sex partner Concern that pregnancy will compromise woman's health Fear of leaving orphans Fear that others will be unwilling to care for the family during illness Stigma and discrimination
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Role of HIV Service Provider

Providers see their HIV-infected patients on a routine basis Providing several services at one location eliminates the care-seeking burden on the patient
It increases the likelihood that patients will get the care they desire The provider can address family planning and pregnancy in the

context of HIV-specific needs of the patient

NO MISSED OPPORTUNITIES!
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Examining Own Values (1)

Paste around the room the signs Agree, Disagree, Not sure. Instruct participants to listen carefully to each statement as you read it.
Participants should rate themselves on the agreement scale:

Agree, Disagree, Not sure as regards the statement and then move to where the sign is hanging. Ask a few participants to explain why they made their stated choice.

Explain the ground rules of this exercise: Be truthful about your choices. There is no right or wrong answer or opinion the purpose of this exercise is simply to identify our own values about the issues.
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Examining Own Values (2)

Do you believe that
People with HIV should be free to have children like everyone else? HIV testing should be mandatory? Men and women with HIV should be urged to undergo sterilization? People with HIV should be encouraged to have children while they are still healthy? If an HIV infected person refuses to disclose his/her HIV status to his/her partner, the health worker should notify the partner?
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Examining Own Values (3)

Do you believe that
Sex should be a pleasurable experience for both the man and the woman? Men are responsible for the spread of HIV? Discordant couples should be encouraged to abstain from sex? Men should be the primary family planning decisionmakers? Girls should practice abstinence until marriage?
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Examining Own Values (4)

It is important to examine your own attitudes and beliefs about sexual behaviour and reproductive health for HIV-infected people. These attitudes and beliefs can impact the care you provide and how the patient accepts that care. While it is expected that you will hold your own opinions and beliefs, it is important for you to respect that your patients may have different opinions and beliefs.

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