Analysis Health Systems

In One Place: Why We Need to Integrate Family Planning and HIV/AIDS Services

Danielle Zielinski

For too many, accessing health care is a challenge. Integrating reproductive health and HIV/AIDS services–providing both services under one roof–makes it easier for women to get what they need.

Cross-posted with permission from Care2.

Naomi Daka smiles and swings her arms, singing along with the other women in a back room of the Chawama Health Centre. It’s the end of her weekly meeting of her support group, “Mothers to Mothers.”

When Naomi was first diagnosed with HIV, she thought her life was over. But through counseling and the support of other women like her, she is not only leading a full and productive life, but has since had two healthy children who are HIV-negative.

“The counselors told us that being HIV positive is not the end of everything. You can do whatever you want and have a chance to excel in life,” Naomi says. “I did not get worried falling pregnant because I planned… I was taught on how I can take care of myself if I wanted to be pregnant.”

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Unfortunately, many women aren’t as lucky as Naomi. Sixty percent of the 22 million people living with HIV in Sub-Saharan Africa are women. And 53 million women in this region want to avoid pregnancy but cannot access contraception.

For too many, accessing health care is a challenge. Women wake up early to line up at clinics as early as 4 am. They may travel for hours just to reach a health center, or wait all day to receive care. They miss work, and spend time away from their families. And most of them don’t even get everything they need. When it comes to HIV and reproductive health services, it’s rare that a woman can find both in the same place.

Voluntary contraception is an essential HIV prevention tool. Despite this knowledge, contraceptives are not widely available in HIV/AIDS settings and obstacles remain for those who wish to access them.

Integrating reproductive health and HIV/AIDS services–providing both services under one roof–makes it easier for women to get what they need. It also enables health care providers to comprehensively address the needs of their clients. Delivering these services together is central to saving lives by ensuring universal access to reproductive health and HIV prevention, treatment, care and support.

Naomi’s story is an example of what can happen when integration works. When she decided she wanted to stop having children, the information and support she got from other HIV-positive mothers was crucial. In a meeting about family planning, the women discussed different methods of contraception–pills, injectables, implants, and IUDs (intrauterine devices). For Naomi, knowing how the methods interacted with HIV treatment was critical to making the right choice for her. She opted for the “loop” contraceptive, an IUD which lasts for 12 years.

“I decide to have a loop because I know that for women who are HIV-positive, the tablets do not work effectively as it is not stronger than the ARVs,” she said. “I talked with my husband. We do not need to have a lot of children, but have the ones we can manage to support.”

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