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Merging health services can reduce HIV infections

By Vision Reporter

Added 27th January 2008 03:00 AM

IMAGINE going to a health centre where you can enrol for HIV prevention, testing and treatment programmes, family planning and other reproductive health services. This is the approach that experts at the recently concluded fifth African Population Conference in Arusha, Tanzania want governments to a

IMAGINE going to a health centre where you can enrol for HIV prevention, testing and treatment programmes, family planning and other reproductive health services. This is the approach that experts at the recently concluded fifth African Population Conference in Arusha, Tanzania want governments to a

By Irene Nabusoba and Alice Emasu

IMAGINE going to a health centre where you can enrol for HIV prevention, testing and treatment programmes, family planning and other reproductive health services. This is the approach that experts at the recently concluded fifth African Population Conference in Arusha, Tanzania want governments to adopt.

Integration, as the scholars, researchers, demographers, policymakers and implementers, at the meeting held every four-years called it, is a critical path in achieving the Millennium Development Goals especially those relating to reduction of HIV infections, plus improving maternal and child health.

The experts argued that integration of related services like Family Planning (FP), Reproductive Health (RH) and Antiretroviral treatment (ART) would help reduce new infections by a two-fold because it is cost effective, reduces stigma, bridges a gap of inaccessibility to services and ensures spill-over benefits.

“Integration of services into one-stop-healthcare centres makes systems more supportive especially for People Living with HIV/AIDS. This approach simply uses a client’s visit to address other health and social needs,” said Dr. William Stone, from the Department of Obstetrics/Gynaecology at the University of Aga Khan, Nairobi.

Stone was discussing ‘Lessons from integration of reproductive health, family planning, and HIV/AIDS programmes’, findings from two pilot projects running in Ghana and Uganda.

He noted that in most developing countries where new HIV infections are still high, efforts are being geared into Prevention of Mother To Child Transmission (PMTCT) programmes alone.

“But it should be a whole package of preventing infections, unwanted pregnancies, post abortion care, PMTCT, treatment and care,” Stone said.
He revealed that in one of their studies, 39,000 HIV positive births were averted through PMTCT while 71,000 were prevented through emphasis of FP.

He hailed the later saying, “When you avoid unintended pregnancies, you avert more infections.”

Research shows that in many of the worst hit countries in sub-Saharan Africa, 10-30% of pregnant women are HIV positive, many of whom end up with unintended pregnancies and stealthy abortions because healthcare systems operate in isolation and fear of disclosure keeps many away. It also happens with orphans and vulnerable children plus youths.

“Healthcare systems have not been tailored to suit the reproductive, family planning and ART needs of youths, orphans and women would be ideal,” says Stone.

In Uganda, a recent report; ‘Unintended Pregnancy and Induced Abortion in Uganda: Causes and Consequences’, notes that because an estimated 440,000 Ugandan women aged 15-49 are HIV positive, the reproductive and sexual health of HIV-infected women, including their access to and use of contraceptives and post abortion services is of great importance.

The report says that pregnant HIV-infected women are hesitant about having children because they fear for their health, and the safety of the newborn child.

Elly Mugumya, the executive director Reproductive Health Uganda (former Family Planning Association of Uganda) says integration of services is something that has been long overdue.

“Given that HIV is a sexuality issue and interlinked, we should have considered integration right from the beginning of our fight against the scourge,” Mugumya says.

He says that integration as an approach comprehensively addresses the causative factor. “Prevention is better than cure. It is the most effective and resourceful approach. We should ensure that new infections are minimised and that the sick live.

Let’s not wait to give ARVS and build orphanages. This can only be possible through integration of FP, RH and ART,” Mugumya stresses.

On whether service providers would end up spreading wings with minimum effects on ground. Mugumya says, “That cannot happen unless provision of services is not matched. Like the case of FP, it is not that we have failed to deliver because of integration.

It is because there has been a constant increase in the population with consequent increase in demand of services with an unmatched provision of services.

“But what is more important is that people are informed and empowered to demand for services because that way, they can make better choices.”

Dr. Henry Kakande of ACQUIRE Project, a USAID-funded scheme piloting integration in Uganda says that as more and more HIV positive men and women gain access to antiretroviral treatment, increasing numbers are living longer and healthier lives.

And like their HIV negative peers, these clients have similar needs for comprehensive, safe, quality FP/RH services.

“But you have heard of positive mothers being shunned in hospitals during childbirth, people being queried why they considered giving birth at all knowing they were positive, communities de-campaigning ART programmes because ‘we are prolonging the lives of People Living with HIV/Aids, who look healthy and go on infecting others.”

“A one-stop-healthcare centre would address all these needs. The providers would be empowered to handle such clients as they come because they are not comfortable opening up to different people and this undermines our efforts in the fight against HIV and AIDS and improving maternal and child health,” Kakande says.

The 2006 State of Uganda Population report says that whereas there has been significant progress in the decline of HIV prevalence, RH indicators remain poor, are stagnating or are in some cases worsening.

The report notes that while political leadership has been demonstrated for HIV, it is almost lacking for other aspects of RH and while the MOH houses programmes to tackle those two areas, they do not plan together.

“These factors have led to an increasing need for policy makers, donors and program implementers alike to enhance the linkages between RH and HIV/AIDS programmes,” it says.

The report says that integration ensures efficiency and convenience for the client and that there is no missed opportunity for RH promotion and HIV and AIDS prevention, treatment and care.

But the report warns that shortages of manpower may undermine its benefits because demand may overburden staff and weaken services.

Besides, FP service personnel may not be trained to offer HIV/AIDS related services and vice versa. “Weak logistics systems are another issue and each aspect requires strong supervision and referrals for management plus follow-up,” the report says.

Merging health services can reduce HIV infections

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