What Works for Women and Girls

A pre-post study from 2004 to 2008 of serodiscordant couples in Kenya found that amultiprong family planning intervention lead to high rates of both condom use andcontraceptive use. Among 213 serodiscordant couples in the intervention group, nonbarriercontraceptive use increased from 31.5% to 64.7% among HIV-positive women andfrom 28.6% to 46.7% among HIV-negative women. At the intervention site, approximately90% of sex acts were reported to be protected by condoms. At other Kenyansites which did not have the intervention, which had a total of 1,216 couples, contraceptiveuse changes from 15.6% to 22.3% for HIV-positive women and decreased from13.6% to 12.7% among HIV-negative women. Pregnancy incidence among HIV-positivewomen in the intervention site, which declined from 21.1 to 11 per 100 woman yearswas approximately half that at other Kenyan sites during the intervention period whichincreased from 16.8 to 21.9 women years. The intervention consisted of: training clinicaland counseling staff on contraceptive methods with job aids to use with clients;provision of free contraceptive methods; appointment cards; ongoing training for staff;ongoing contraceptive supplies; discussions with couples on contraceptives; involvingmale partners in discussions on contraception; and discussions of unintended pregnancies(Ngure et al., 2009). 1 (Gray III) (family planning, contraception, Kenya)A study in Uganda in 2005 found that clients expressed a desire for a wider range ofservices at HIV/AIDS centers. They also noted that FP services are only offered whenrequested by the client or as a result of a provider’s assessment of client needs. Thelimited range of available family planning options and stockouts increases vulnerabilityto unintended pregnancies. Furthermore, reliance on the provider’s assessment orthe client’s initiative to demand family planning services may be unproductive whenthe provider fails to make the correct assessment of the family planning needs or theclient does not feel comfortable initiating a discussion about family planning needs toa provider whose preferred option for the client is abstinence (Asiimwe et al., 2005).(Gray III) (contraception, family planning, treatment, Uganda)A cross sectional survey of 484 women who were HIV-positive and attending an HIVclinic in Uganda, 45% of whom were receiving HAART, found that women receivingHAART were more than twice as likely to use contraceptive methods and more thanthree times as likely to use barrier contraceptive methods than were women notreceiving HAART. Of those 184 women who were sexually active and receiving HAART,84% used barrier contraceptive methods, primarily the male condom. Almost 30%used hormonal contraceptive methods, with injections as the most common hormonalmethods and 5% were sterilized. Women on HAART reported a high degree of dual1 Whether this study was coercive is an issue of concern. The authors state: “Finally, our clinical trial protocol requireddiscontinuation of the study drug for HIV-1-seropositive women who became pregnant, which may havebeen an incentive for study staff to focus family planning messages more strongly towards HIV-1-seropositivewomen.” (Ngure et al., 2009: S94).WHAT WORKS FOR WOMEN AND GIRLS191