Gathering evidence for converging services for HIV and reproductive health

AIDS is everywhere, and protection against the disease needs to be everywhere, too. Shouldn’t a young woman who seeks information on family planning also receive guidance on preventing HIV?

And what about the men and women who tap into HIV services—shouldn’t they be able to get information on other sexually transmitted infections or on preventing pregnancy at the same time?

Focusing outreach efforts and clinical services on just one thing—whether it’s HIV or family planning or reproductive health—is a fast and effective way to reach people with essential health care and information. But a narrow focus can also create missed opportunities to provide a full range of health services.

In India, PATH is researching ways to take every opportunity that comes along to help individuals safeguard their health and well-being—and that means forging links between HIV and AIDS programs and other health services. We call it “convergence.” The real-life stories of Priya and Rani demonstrate the need for convergence of services.

Priya’s story

Twenty-four-year-old Priya from Srikakulam, a town in Andhra Pradesh, contracted HIV from her husband, and she worries about contracting other sexually transmitted infections like warts and herpes. She also suffers regularly from vaginal thrush, which she treats with a home remedy.

Despite her health problems, Priya wants to plan a family. But she wonders, if she has a baby, will it have HIV? She tried asking a few staff at the local HIV-support organization, but they could not advise her. They told her it wasn’t part of their agenda—and counseled her about using condoms and finding treatment for HIV.

If Priya had access to necessary sexual and reproductive health services, including family planning, she could receive treatment for the recurring vaginal thrush infection, and she would have been appropriately advised on the need to have safer sex until she wants to become pregnant. Family planning experts would inform her of the risks of transmitting HIV to her baby—and tell her that a readily available drug, nevirapine, could greatly reduce the chances of mother-to-child transmission. Once she became pregnant, they would help her access prenatal care, assistance with the birth, and postpartum care.

Rani’s story

Rani is a 24-year-old sex worker in Patna, the capital city of the populous state of Bihar. Rani has two daughters and does not want to have any more children, yet she feels powerless to prevent pregnancy. She knows that condoms are important, but she can’t get all her customers to use them. Meanwhile, Rani frequently deals with heavy bleeding and a feeling that her uterus “comes out.” She’d see a doctor but dreads being judged. Instead, she’s hoping that local practitioners’ herbal treatments can help her.

Rani’s health needs are full-spectrum. She needs information, ideas, and tools that can help her prevent pregnancy and protect herself from HIV and other sexually transmitted infections. She needs treatment for genital prolapse and any infections she already has. And with her fear of being shamed, Rani needs to know that health workers will respect her and her privacy. Ideally, she could make just one first contact with the health system—and be guided to the information and services she needs from there.

More about convergence

At a basic level, convergence involves setting up systems for mutual referrals and communication, so that the women and men who access HIV services are referred to the appropriate sexual and reproductive health services, and vice versa.

Converging services also can involve developing dual-purpose interventions and integrating services. For example:

• Combining the diagnosis and treatment of sexually transmitted infections (currently provided at designated clinics) with the diagnosis and treatment of infections of the reproductive tract (currently provided as part of obstetrics and gynecology outpatient services).
• Counseling parents on preventing mother-to-child transmission of HIV (currently part of HIV services) during prenatal visits and delivery (currently part of gynecology and obstetrics services).
• Adding voluntary counseling and testing for HIV to family planning services.
• Introducing family planning services in HIV clinics.
• Providing sex education and counseling about HIV, life skills, and reproductive health all together as part of family planning services and HIV services.

To understand how convergence could work in India, PATH convened groups of sexually active young men and women, female sex workers, and people with HIV in four states—Andhra Pradesh, Bihar, Maharashtra, and Uttar Pradesh—and gathered information and ideas about how these populations interact with health care services. We also interviewed service providers and policymakers and disseminated the results of all this research at state-level meetings, where participants identified and prioritized models of convergence. PATH is now working with state governments to test the models and document successes and lessons learned.

Photo: Richard Lord.