Family planning and HIV services work well together

People living with HIV in Kenya do not have adequate access to family planning services, even though most HIV-infected women do not want children in the immediate future.



A recent study by the reproductive health NGO, Family Health International (FHI), in the Nakuru district of Rift Valley Province, found that 80 percent of HIV-positive women had no intention of having a child in the next two years. However, according to the 2007 Kenya AIDS Indicator Survey, only half the HIV-positive people needing family planning services had access to them.



"Most prevention of mother-to-child transmission [PMTCT] programmes ... looked at it only in the context of preventing transmission to an already conceived child, but meeting contraceptive needs of those living with HIV is a sure way of reducing ... transmission by avoiding unwanted pregnancies in the first place," said Maureen Kuyo, a project director at FHI.



Sylvia Mate* said staff at the antenatal clinic she attends in Mukuru, a slum in the capital, Nairobi, have never mentioned contraception, even though they know she and her husband already have three children. She believes condoms are a contraceptive method for unmarried people who have several sexual partners, and is unwilling to use them.



"I know there are other family-planning methods, but we are not even told whether those other contraceptives are safe for somebody like me [HIV-positive] or not," she said. Mate is determined that her current pregnancy will be her last, even if it means seeking an illegal and possibly dangerous abortion.



About 56 percent of women in the FHI study mentioned a fear of vertical transmission of HIV to their children as one the reasons they would not want another pregnancy, while 50 percent mentioned the risk of lowered immunity during pregnancy.



"It is important to realize that we have a sexually active population, including people living with HIV, and this should be reason enough to strengthen family-planning programmes and integrate them into HIV and AIDS programs, including offering family-planning counselling at voluntary counselling and testing (VCT) centres," FHI's Kuyo said.



An earlier FHI study found that offering family planning services during VCT was feasible and acceptable to providers as well as clients, and that integration did not negatively affect VCT quality.



Experts have noted that integration would require additional staff training, and materials for family planning would need to be distributed at VCT and PMTCT centres across the country.



"HIV service providers are beginning, in a small way, to talk to people on their family planning needs," Kuyo said. "Access is improving, but there is still along way to go."



* Not her real name



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