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Challenges to Integration
For example, some decision makers have feared that providing STI services might stigmatize a reproductive health program. Yet frontline providers are often the first to recognize that their clients need STI services, and offering such services within a reproductive health setting reduces the stigma of seeking such services from the client’s perspective. Some decision makers may fear that integration would dilute the reproductive health services offered and take away important resources, while others who have integrated services have found that it improves the quality of care. Quality is improved through providing a broader range of services to better meet client needs. Integration can also improve the quality of education and counseling and improve client satisfaction. Many have cited the extra time it would take to counsel a client about STI/HIV prevention in addition to family planning as a barrier to integration. However, some programs have found that time can actually be saved by shifting the approach to counseling away from a detailed description of the methods and side effects and toward a more personalized approach. Through such an approach, the counselor first explores a client’s sexual life and circumstances and then provides information specifically pertinent to that client, including STI/HIV information when appropriate. Perhaps the most often cited disadvantage to integration relates specifically to the limitations of STI syndromic management for vaginal discharge, and the fact that women may not be the best population to focus STI resources on in order to achieve the largest population impact. (For a more detailed discussion of this topic, see EngenderHealth's online Sexually Transmitted Infections course.)
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Many
challenges and perceived advantages and disadvantages to integrating STI/HIV
prevention and services exist within reproductive health services. 