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Reproductive Health |
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During the client assessment at the beginning of each counseling session, HIV counselor Sylvia Madakadze asks about something she never used to talk much about: family planning. "Are you currently using a method?" she asks. "If so, which method?" She returns to the subject during post-test counseling, when she and her clients discuss how to avoid transmitting or acquiring HIV in the future. "It is easy to blend it [family planning] in," says Madakadze, site manager at the Genesis New Start Centre in Harare. She was among the first 50 HIV counselors to receive training as part of a Zimbabwe HIV & AIDS Partnership Project initiative to strengthen HIV and family planning service integration in Zimbabwe (see Integrating Family Planning and HIV in Zimbabwe).
First established by Population Services International (PSI) in 1999, the USAID-funded New Start program provides HIV counseling and testing services to an average of 20,000 clients per month at 20 centers for a modest fee and through free outreach services. All 120 New Start counselors and the 22 counselors at the project's five post-test support centers were trained in family planning counseling in 2006. To help counselors better understand their clients' family planning options, the FHI/EngenderHealth training module, Contraception for Women and Couples with HIV, was adapted for use in a two-and-a-half-hour session that is offered during New Start counselors' regular pre-service or refresher training. "Family planning was always part of the counseling, but some counselors were not doing it, and some were only talking about condoms," says Dr. Karin Hatzold, PSI's senior HIV/AIDS advisor in Zimbabwe. The counselors particularly enjoyed the family planning component of their training "because the information was relatively new for them," she added. "The fact that family planning was an important part of PMTCT [prevention of mother-to-child transmission of HIV] was an eye-opener." Five new questions on the centers' client intake forms remind counselors to discuss family planning with clients and help monitor whether those discussions take place. Counselors continue to advise consistent condom use for both the 30 percent of clients who test positive for HIV and those who test negative. Now they also discuss the limitations of condoms for contraception, provide information on other methods, and promote dual method use to prevent unintended pregnancies and sexually transmitted infections, including HIV. New Start counselors offer clients condoms and refer them to nearby sources of family planning services for other methods. Counselors at the Genesis Centre say such services are accessible to their clients; outreach services in more remote areas are usually offered in local clinics that provide contraceptives. Family planning referrals have been added to the New Start referral tracking system, which can confirm successful referral of almost half of its clients. Client response to family planning counseling has been positive, particularly among young people who have no other source for such information. "It seems that clients are more interested in our service because we are also offering family planning counseling," says Genesis counselor Marvis Mudzana. Reference
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