Integrating Family Planning into HIV Programs:

Why should family planning and HIV be integrated?

Like all women, men, and couples, people living with HIV have diverse fertility desires.

Data from diverse countries like these

confirm that women living with HIV experience high rates of unmet need for family planning and unintended pregnancies.

Integrating family planning and HIV services is desirable for many clients and has important potential individual, program, and public health benefits.

Gives the client more control over his or her reproductive health and fertility

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Allows for ongoing contraceptive management when clients come in for regular HIV-treatment services

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Increases the promotion of dual-method use

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Reduces new pediatric HIV infections, and the number of children needing HIV treatment, care and support

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Supports gender equity

Political, religious, or community opposition to FP

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Lack of government support

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Vertical funding for and national management of FP and HIV programs

Insufficient involvement of people living with HIV

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Lack of youth-friendly services

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Lack of community awareness and mobilization

Human resource constraints

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Limited clinic space

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Lack of supportive supervision

Provider biases and stigma

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Lack of FP knowledge among providers

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Fears about interactions between FP and ARV medications

Absent or weak referral systems between FP and HIV service delivery points

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Contraceptive stockouts

Some of the countries where FP and HIV integration is underway - from situational analyses to national-level scale up

For example, levels of integration will vary per setting.

Some facilities may only have the capacity to offer FP screening, information, condoms, and referrals for methods, while others may be able to provide FP counseling and a full range of contraceptive methods.

Two essential elements for training are:

Orienting providers to the SRH rights of people living with HIV - including key populations - and addressing provider biases (e.g., that they should not bear children, are not sexually active, should only use condoms, or be sterilized)

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Ensuring that providers are able to counsel on the full spectrum of fertility choices, including safer pregnancy and the range of safe and effective contraceptive methods for HIV-positive clients

From Roots to Results:

Evidence-Based Practices for Integrating Family Planning

into HIV Programs

Meets client desires and demand

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Reduces unmet need for family planning

Increases access to and uptake of contraception by people living with HIV who wish to prevent pregnancy

Improves HIV-related outcomes

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Strengthens male involvement in family planning

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Holds potential to reduce costs

What is the impact of integrating family planning and HIV services?

What measures can be taken to advance family planning and HIV integration?

Address constraints and introduce reinforcements at multiple levels of the health system, such as:

Be strategic and pursue "smart", context-specific integration

Government leadership, policy linkages, and coordinating bodies

Civil society and community engagement

Ongoing research

Information systems and M&E

Supply chain and commodity security

For access to the full technical brief of this evidence synthesis, which includes descriptions of the specific research findings and data, a full bibliography, and suggestions for key tools and resources, please go to:

http://www.fhi360.org/resource/select-family-planning-and-hiv-integration-resources

Barriers that reduce the effectiveness of integrated FP/HIV programs

Male involvement

Training and other human resource considerations

Facility infrastructure and space considerations

Communication and demand generation, including dual-method promotion

Unintended pregnancy among women living with HIV carries significant risks for mothers and children.

Policy and financial support for integrating family planning and HIV services is robust and continues to grow.

Consensus in the global health community affirms that linking family planning and HIV is essential for meeting international development goals, including achieving an HIV-free generation and ensuring access to reproductive health services.

Family planning services can be integrated into HIV health systems strengthening, prevention, counseling and testing, PMTCT, and care and treatment. Different types of integration might be appropriate for different health care facilities or programs.

Integrating family planning services into HIV programs can increase access to contraception, or help ensure a safe and healthy pregnancy and delivery for those who wish to have a child.

What is family planning and HIV integration?

Why is family planning and HIV integration important?

In 2013, with support from USAID, FHI 360 reviewed 97 resources (including peer-reviewed articles as well as programmatic and technical materials) to identify evidence pertaining to: the rationale for integrating family planning (FP) and HIV services; facilitators of and barriers to successful integration; the impact of integrated FP/HIV services; and recommendations to advance effective delivery of integrated services.

What follows is a summary of the evidence.