Promoting Dual Protection in Family Planning Clinics in Ibadan, Nigeria
Adeokun, Lawrence, Mantell, Joanne E., Weiss, Eugene, Delano, Grace Ebun, Jagha, Temple, Olatoregun, Jumoke, Udo, Dora, Akinso, Stella, Weiss, Ellen, International Family Planning Perspectives
CONTEXT: Integration of efforts to pre vent HIV and sexually transmitted infections (STIs) and of condom promotion into family planning services is urgently needed because of the escalating HIV epidemic in Sub-Saharan Africa.
METHODS: Counseling on dual protection--concurrent protection from unintended pregnancy and HIV and other STIs--and provision of the female condom were introduced in six family planning clinics in Ibadan, Nigeria. Structured observations of interactions between clients and service providers, clinic service statistics, provider interviews, and other qualitative and quantitative methods were used to assess family planning providers' promotion of dual protection.
RESULTS: Following intensive training, providers delivered dual-protection counseling to a majority of clients and demonstrated the female condom to 80% of the new clients observed. Discussion of the sexual behavior of clients and their partners, of the relative ability of various contraceptives to protect against HIV infection and of how to negotiate condom use increased significantly, as did STI assessment. Providers' internalization of the importance of HIV/AIDS prevention was crucial to promoting and sustaining the dual-protection initiative. Condom purchases increased from a baseline of2% of all family planning visits in 1999 to 9% January--June 2001. This increase came mainly from acceptance of the female condom, used either alone or in conjunction with another contraceptive.
CONCLUSIONS: Integrating dual-protection counseling and female condom provision into family planning services appears feasible, as is service providers' acceptance of dual-protection objectives. While providers and clients are key to transforming family planning to dual-protection services, the attitudes and behaviors of clients' male partners must be considered in gauging the success of the dual-protection intervention.
With the rapid spread of HIV throughout Sub-Saharan Africa, new approaches to HIV prevention are urgently needed, especially among young women. Family planning services have traditionally focused on promoting methods that are highly effective at preventing pregnancy but provide no protection against HIV. Further, thousands of women receiving family planning services every day are not informed of what they can do to protect themselves from HIV infection.
Since the mid-1990s, various strategies have been implemented, primarily in Africa and in Latin America and the Caribbean, to integrate family planning with HlV and sexually transmitted infection (STI) services. (1) These efforts have consisted primarily of teaching family planning providers about HIV and STIs and of providing STI treatment; however, they have not been shown to be effective in increasing condom use. (2) They have also generally failed to promote the condom's role in dual protection--a strategy for providing concurrent protection from unwanted pregnancy and disease prevention, mainly through the use of condoms (either alone or in conjunction with another method). (3)
Structured observations of family planning services in Botswana, Ghana, Kenya, Zambia and Zimbabwe showed that only one-quarter of family planning clients had received information on HIV and other STIs and that fewer than one-third had heard about the dual-protection benefits of condoms. (4) The compartmentalization of family planning services from HIV and STI prevention in health care delivery systems has generated the need for a paradigm shift in family planning services--one that places family planning and HIV and STI prevention under a single umbrella. (5)
Integrating dual protection into family planning services will require changes in service-delivery practices and policies, including making newer HIV and STI prevention options (such as the female condom and, when they become available, microbicides) available, documenting dual-protection practice within management information systems and changing how family planning service providers perceive their role and carry out client counseling. …