HIV/AIDS and Sexual and Reproductive Health Integration: Quarterly Highlights Newsletter (April 2010)
Contents
Kampala Follow-Up
In November of 2009, the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Makerere University’s School of Public Health, and the Implementing Best Practices Initiative, along with other international and national partners, organized the International Conference on Family Planning: Research and Best Practices in Kampala, Uganda. With over 400 presenters and 1,300 participants the conference was a major success.
In order to maintain the energy and excitement displayed in Kampala, an online community of practice, Kampala Conversations: Knowledge to Action for Family Planning, was created on the Implementing Best Practices (IBP) Knowledge Gateway. This is an online space where everyone can share information, resources and knowledge about international family planning Go to http://my.ibpinitiative.org/public//kampalaconversations to join for free.
Maternal deaths fall worldwide
The Institute for Health Metrics and Evaluation (IHME) at the University of Washington and collaborators at the University of Queensland announced this month in The Lancet that the number of women dying from pregnancy-related causes decreased more than 35% between 1980 and 2008. Much of the improvement in maternal mortality was in developing countries. HIV remains a significant obstacle to further reducing maternal mortality and is related to nearly one out of five maternal deaths. Read the journal article in the Lancet and the press release from IHME.
Guides for Integration
Source: Path
The aim of this capacity-building toolkit is to provide practical guidance for building capacity of various institutions to converge or integrate HIV and SRH services strategically, so that people who are living with HIV or are most at risk of HIV can access the SRH services they need without any barriers. The capacity-building toolkit focuses on (a) building capacity of non-governmental organizations (NGOs) and community-based organizations (CBOs) for generating demand for SRH services among people living with and most at risk of HIV; and (b) strengthening the capacity of health service providers to meet the sexual and reproductive health needs of these populations with quality services.
Family Planning and HIV Services Integration Toolkit
Source: K4Health and Family Health International
This toolkit is your one-stop source for evidence-based knowledge and promising practices to support the successful integration of family planning (FP) and HIV services. This toolkit summarizes the latest evidence and provides links to guidelines and tools to help you plan, manage, deliver, evaluate, and support integrated services.
Move together now! Community and youth mobilisation for HIV prevention among young people in Uganda
Author: Uganda. Ministry of Gender, Labour and Social Development
Source: [Kampala, Uganda], Ministry of Gender, Labour and Social Development, [2009]. [98] p.
This guide covers basic ideas on community mobilization, youth participation, and participatory tools with examples from Africa. It provides tools, processes, and activities for mobilizing young people and communities to address youth sexual reproductive health, including HIV prevention.
Integration Activities in the Field
Authors: Kombo A.
Source: Nairobi, Kenya, EngenderHealth, APHIA II Nyanza Project, 2009. 11 p. (USAID Cooperative Agreement No. 623-A-00-06-00020-00)
The central strategy of the APHIA II Nyanza health facility-based services component is to build the capacity of the Ministry of Health to increase access to and quality of health services, as well as to integrate services. The two main objectives of APHIA II Nyanza health facility-based activities are to: Expand the availability of HIV and AIDS prevention, care, and treatment services, including tuberculosis and male circumcision services [and] Expand the availability of reproductive health / family planning and maternal and child services, integrated with HIV and AIDS services.
Related document: Implementation strategy of the APHIA II Nyanza Project (AIDS, Population, and Health Integrated Assistance, June 2006 - December 2010).
Moving forward: Pathfinder International's contribution to the global HIV and AIDS response
Authors: Pathfinder International
Source:Watertown, Massachusetts, Pathfinder International, 2009. 9 p.
Moving Forward offers an overview of Pathfinder's comprehensive approach to prevention, care, and treatment of HIV and AIDS in developing countries. Pathfinder's eight priority intervention areas are illustrated through highlights of country projects, as well as references to relevant publications and tools.
Arguments for Integration
Five good reasons to integrate family planning /reproductive health and HIV services
Author: Ringheim K.
Source: Washington, D.C., Population Reference Bureau [PRB], 2009 Dec. [2] p.
This article highlights five good reasons why integration is a sound investment that will pay multiple dividends for individuals, communities, societies, and health systems.
Integrating reproductive health and HIV services advances gender equity and human rights
Author: Ringheim K.
Source: Washington, D.C., Population Reference Bureau [PRB], 2009 Dec. [2] p.
Integrating family planning and reproductive health and HIV services is an important strategy to reduce new HIV infections and unintended pregnancies and promote gender equality and human rights. Such integration is essential at a time when, despite a massive increase in resources devoted to fighting HIV / AIDS, only a negligible reduction in new HIV infections has been achieved. Furthermore, more than 200 million women have an unmet need for contraception to prevent an unintended pregnancy.
Research
Author: Obi SN; Onah HE; Ifebunandu NA; Onyebuchi AK
Source: Journal of Obstetrics and Gynaecology. 2009 May;2.9(4):329-32.
This questionnaire survey explored the sexual practices and problems of 184 HIV-positive individuals in two tertiary health institutions in south-east Nigeria over a 6 month period. It showed that many (56.5%) HIV-positive individuals continue to be sexually active and almost half (47.6%) of them do not know the sero-status of their partners. About 60% (n = 62) of sexually active respondents use condoms with 27.9% using them consistently, 31.7% inconsistently, while 40.4% engage in unprotected intercourse. Condom use was more among the male than the female respondents (p < 0.05) and the married or divorced couples than the unmarried (p > 0.05). Diagnosis of HIV resulted in increased abstinence (37.3%) due to loss of interest in sex and/or loss of partner. Almost half (49%) of the respondents had sexually related problems in the form of lack of sexual desire (82.4%), erectile dysfunction (25.5%) and ejaculatory problems (5.9%). These problems are more in the first 6 months of HIV diagnosis and are probably psychological. There is a need for continued discussion on safe sexual practices with HIV-positive individuals during the course of routine clinical consultation.
Kenya AIDS Indicator Survey (KAIS) 2007. Data sheet.
Author: Kenya. National Coordinating Agency for Population and Development [NCAPD]; Population Reference Bureau [PRB]
Source: [Nairobi], Kenya, NCAPD, 2009 Jul. 9 p.
Representative estimates on behavioral, clinical, and biological HIV / AIDS indictors are critical for evaluating a country's response to the HIV epidemic. National population-based surveys with HIV testing provide national-level prevalence estimates and the opportunity to link HIV status with behavioral, social, demographic, and other biological information. The 2007 Kenya AIDS Indicator Survey (KAIS) was Kenya's first survey of this kind and provides comprehensive information on HIV and other sexually transmitted infections. These data provide the information needed for planning interventions for HIV prevention, care, treatment, and allocation of resources. The 2007 KAIS survey was conducted in all eight provinces and nearly 18,000 men and women between the ages of 15 and 64 years participated. The 2007 KAIS was carried out by the Kenya National AIDS and STI Control Program (NASCOP), Kenya National AIDS Control Council (NACC), Kenya National Bureau of Statistics (KNBS), National Public Health Laboratory Services (NPHLS), Kenya Medical Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD).
Nigeria Demographic and Health Survey 2008
Author: Nigeria. National Population Commission; ICF Macro. MEASURE DHS
Source: Abuja, Nigeria, National Population Commission, 2009 Nov. [660] p.
The 2008 Nigeria Demographic Health Survey (NDHS) is a nationally representative survey of 33,385 women age 15-49 and 15,486 men age 15-59. The 2008 NDHS is the fourth comprehensive survey conducted in Nigeria as part of the Demographic and Health Surveys (DHS) programme. The data are intended to furnish programme managers and policymakers with detailed information on levels and trends in fertility; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; infants and young children feeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV / AIDS and other sexually transmitted infections. Additionally, the 2008 NDHS collected information on malaria prevention and treatment, neglected tropical diseases, domestic violence, fistulae, and female genital cutting (FGC).
Author: Sikwese S
Source: [Baltimore, Maryland], Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Knowledge for Health [K4Health], 2009 Nov. 24 p. (Knowledge for Health Summary Report; USAID Cooperative Agreement No. GPO-A-00-08-00006-00)
This report presents an analysis and summary of key findings from the Knowledge for Health (K4Health) needs assessment conducted in Malawi from July - September 2009. The study used qualitative methods to determine the need for health information in HIV / AIDS and family planning / reproductive health (FP / RH) at all levels of the health system; commonly used channels for accessing and sharing information; and challenges faced by different cadres of managers and health providers when seeking or sharing information. The study was conducted in the capital city, Lilongwe, and three districts: Salima, Nkhotakota, and Blantyre. Key informants for the study included directors, managers and health providers working in HIV / AIDS and FP / RH within the public and NGO sectors at the central and district levels. In addition, focus group discussions (FGDs) were held with health facility staff and community health workers (CHWs). Findings show that there is a substantial information gap among managers and health providers working at all levels in HIV / AIDS and FP / RH. The study also reveals a number of challenges that managers and service providers encounter when seeking information.
A measure of commitment: Women's sexual and reproductive risk index for sub-Saharan Africa
Author: Centre for the Study of Adolescence; Population Action International
Source: Nairobi, Kenya, Centre for the Study of Adolescence, 2009. [66] p.
In 2008 the number of African women who died from pregnancy and child birth was much higher than the number of casualties from all the major conflicts in Africa combined. Maternal mortality continues to be the major cause of death among women of reproductive age (15-49) in Sub-Saharan Africa (SSA). Most of these women die from complications that can often be effectively treated in a health system that has adequate skilled personnel, a functioning referral system and can respond to obstetric emergencies when they occur. This report looks at the performance of Sub-Saharan African countries in meeting reproductive health targets in 47 countries and ranks them using a set of ten indicators in order of the highest to lowest risk. It highlights the need to increase the level of investment in reproductive health, step up policy reform and implementation, expand access to services in rural areas, strengthen health systems, promote the realization of rights and abolish retrogressive cultural practices that perpetuate gender inequities and put the lives of women and girls at risk.
Male Circumcision
Print media reporting of male circumcision for preventing HIV infection in sub-Saharan Africa
Authors: Wang AL; Duke W; Schmid GP.
Source: Bulletin of the World Health Organization. 2009 Aug;87(8):595-603.
The objective of this study was to review the types, content and accuracy of print media reports on male circumcision for preventing HIV infection among men in sub-Saharan Africa. Researchers judged the accuracy of the reports and determined the context, public perceptions, misconceptions and areas of missing information in the print media. We also explored whether the media could be better used to maximize the impact of male circumcision. Most articles (56.0%) presented male circumcision for the prevention of HIV infection in a positive light. Those that portrayed it negatively had an overall repeat rate 2.9 times higher than positive articles. Public health messages formulated by international health agencies were few but generally accurate. The accuracy of the reports was good, although the articles were few and frequently omitted important messages. This suggests that public health authorities must help the media understand important issues. A communication strategy to sequence important themes as male circumcision programmes are scaled up would allow strategic coverage of accurate messages over time.
New & Improved Barrier Method Technologies
Author: Lara DK; Grossman DA; Munoz JE; Rosario SR; Gomez BJ; Garcia SG.
Source: AIDS Education and Prevention. 2009 Dec;21(6):538-51.
To assess the acceptability and use of the female condom and diaphragm among female sex workers in the Dominican Republic, 243 participants were followed for 5 months. Participants received female and male condoms and a diaphragm along with proper counseling at monthly visits. Seventy-six percent reported used of female condom at least once during the final month of the study, compared with 50% that used the diaphragm with male condoms and 9% that used the diaphragm alone. The proportion of women reporting every sex act protected with some barrier method increased from 66% at first month to 77% at final month (p < 0.05). Participants reported higher acceptability and use of the female condom than the diaphragm. The introduction of female-controlled barrier methods resulted in the use of a wide range of prevention methods and a significant reduction in unprotected sex.
Author: Mbopi-Keou FX; Trottier S; Omar RF; Nkele NN; Fokoua S; Mbu ER; Domingo MC; Giguere JF; Piret J; Mwatha A; Masse B; Bergeron MG.
Source: Contraception. 2010 Jan;81(1):79-85.
Invisible Condom gel formulations being developed as microbicides to prevent the sexual transmission of HIV are advancing through the phases of clinical trials. The objectives of this study were to evaluate, after 8 weeks of vaginal application, the extended safety and acceptability of two Invisible Condom vaginal gel formulations: (i) the polymer alone and (ii) the polymer containing sodium lauryl sulfate (SLS) compared to placebo. This study is a randomized, doubled-blind, placebo-controlled Phase II extended safety study in healthy sexually active women from Yaounde, Cameroon. Women were randomized into three gel arms: (i) placebo, (ii) polymer alone and (iii) polymer/SLS. Women applied gel intravaginally twice daily for 8 weeks. Invisible Condom gel formulations were well tolerated with no reported serious adverse events. The majority of reported adverse events were mild or moderate and mostly similar in all three arms, except for pelvic pain that was 10% higher in the polymer and polymer/SLS arms compared to placebo. Colposcopy showed neither genital ulceration nor mucosal lesions. Nugent score, H(2)O(2)-producing lactobacilli and vaginal pH were not affected by the study products. The gel formulations and applicator were generally acceptable and comfortable. This extended safety study showed that the Invisible Condom gel formulations and applicator were well tolerated and acceptable when applied intravaginally twice daily for 8 weeks. Thus, further phases of clinical development of Invisible Condom as a potential microbicide to prevent sexual transmission of HIV are warranted.
This section lists upcoming public health conferences, meetings, or other events that include activities and information concerning HIV/AIDS and Sexual and Reproductive Health Integration. If you know of an upcoming event that may be of interest to HIV/SRH Integration professionals, please e-mail info@hivandsrh.org.
The 29th Annual Family Planning and Reproductive Health Conference, Honolulu, Hawaii, May 5-6, 2010
Microbicides: Building Bridges in HIV Prevention (M2010), Pittsburgh, Pennsylvania, USA, May 22-25, 2010
International Multi Secotral Conference: Women and Youth Empowerment and HIV/AIDS Prevention- The Way Forward, London, UK, May 24- June 3, 2010
4th INTEREST Workshop- International Workshop on HIV Treatement, Pathogenesis, and Prevention Research in Resouce-Limited Settings, Maputo, Mozambique, May 25-28, 2010
Global Health Council 2010 Conference, Washington, D.C., June 14-18, 2010
4th International Conference on Peer Education, Sexuality, HIV&AIDS - HIV Prevention: Uncovering New Ground, Nairobi, Kenya, June 16-18, 2010
XVIII International AIDS Conference, Vienna, Austria, July 18-23, 2010
3rd Botswana International HIV Conference 2010, Gaborone, Botswana, October 13-16, 2010
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HIV/AIDS and Sexual and Reproductive Health Integration: Quarterly Highlights is published by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs. It is made possible through funding from the David and Lucile Packard Foundation and the William and Flora Hewlett Foundation.