This brief examines a family planning (FP)/HIV integration programme to prevent primary infection of HIV and unintended pregnancies in young women, as well as vertical (from mother to child) and horizontal (from one sexual partner to another) HIV transmission in infected women and discordant couples. Developed by Populations Services International (PSI)/Zimbabwe under the Strategic Alliances with International NGOs (SALIN) project, funded by the Dutch government, the programme was launched in October 2008, with activities aimed at increasing both awareness and adoption of dual protection (DP), which is the concurrent use of condoms and other contraceptive methods to prevent unintended pregnancies as well as HIV and sexually transmitted infections (STIs), among these groups: young women (age 15 to 29), infected women, and discordant couples.
As detailed here, the programme used the following 3 strategies to achieve this goal (communication elements are emphasised below; see the full brief for other outcomes):
- Integration of FP with HIV testing and counselling (T&C) and prevention services for people living with HIV (PLHIV) - PSI/Zimbabwe initiated HIV T&C services, branded "New Start", in 1999. Today, 19 static centres and 23 mobile teams reach more than 35,000 people with T&C and FP services every month. Fifteen of the static sites and 14 of the mobile teams are operated by local partner organisations. With support from SALIN, PSI/Zimbabwe trained 250 counsellors from the New Start network in FP service delivery, counselling, and referral, which led to integrating FP into 42 T&C sites. From October 2008 to January 2010, a total of 334,000 T&C clients received FP and DP counselling. Using FP cards and flipcharts developed by the programme, the counsellors help their clients identify the most suitable FP method based on the clients' individual needs. During the sessions, special emphasis is placed on the importance of DP use, and counsellors demonstrate both female and male condom use. Although the majority of New Start clients reported current use of a FP method during their visit, 3,948 new clients were referred to FP providers for consultation. The New Start teams follow up with all referred clients, ensuring that the referral has been successful.
- Targeted interpersonal communications (IPC) and marketing and distribution of hormonal contraceptives through the private and public health sector - In 2004, PSI created a network of post-test support services (PTSS) at centres branded "New Life". These centres provide psychosocial support and counselling for people living with HIV. The network has grown from 4 to 15 centres countrywide and includes mobile teams that visit hospitals and antenatal clinics, providing support for HIV-positive mothers, post-delivery. Twelve of the centres and mobile teams are managed by local partner organisations. More than 100 counsellors from New Life centres received training in FP counselling, FP service delivery, and referral in a combined training with New Start counsellors. PSI/Zimbabwe developed information, education, and communication (IEC) materials including counselling cards for one-on-one counselling sessions, as well as brochures and posters. Between October 2008 and January 2010, 104,000 HIV-positive women and couples participated in FP and DP counselling through the New Life programme; 1,659 were referred to FP service providers (many New Life clients already use one FP method). Also, a flip chart was developed to guide New Start and New Life counsellors during FP counselling sessions and IPC small group discussions that take place in colleges, workplaces, and high-risk areas such as small urban settlements situated in rural areas.
- Awareness and demand generation for dual protection through national mass media - PSI conducted an initial population-based survey. Based on findings, the communication strategy for DP was developed to include a balanced mix of mass media and IPC campaigns to increase personal risk perception, to communicate the positive benefits of DP (versus the limitations of using a single method), and to enhance women's negotiation skills to be able to introduce DP to their partner. Elements here include:
- PSI/Zimbabwe developed a series of 15-minute radio programmes to explain the concept of DP and its protective benefits against HIV and unintended pregnancy. The radio programmes discuss the challenges of practicing DP and the negotiation skills needed to introduce the practice into sexual relationships. To date, 8 programmes produced in Zimbabwe's 2 major languages have been recorded and are airing during prime listening time. As of November 2009, 500 radio sessions had been broadcast. By the end of the project, a total of 5,000 radio spots are expected to be broadcast.
- PSI/Zimbabwe developed a television campaign to increase risk perceptions around using a single method only. The campaign uses simple analogies of how certain objects are more beneficial when there are two of them instead of one, such as by portraying a woman limping with only one shoe, a cyclist struggling on a bicycle with one punctured wheel, and a man squinting in the sun while wearing a pair of sunglasses with only one lens. A total of 300 TV spots are expected to air before the end of the project.
- PSI/Zimbabwe is working in partnership with local youth-based organisations to reach out to women in universities with messages on DP. Dual protection messages have also been integrated into small group discussions in rural growth points, mining and farming settlements. These discussions are designed to engage young women and older men. Between October 2009 and January 2010, a total of 18,632 individuals were reached through road shows promoting DP. The programme aimed to reach 25,000 people with 500 discussions about DP in colleges, homes, and churches by the end of 2010.
In conclusion: "Counseling combined with direct, onsite access to FP methods as well as female and male condoms or counseling combined with strong linkages to FP service providers can increase DP use among women and couples. Lessons learned from the successful integration of FP T&C delivery supplemented with strong referral systems with T&C and PTSS can be used in other countries in the region. The DP communications campaigns can also be adapted for use by other platforms working on HIV and family planning."
PSI website, December 10 2010.