HIV and Reproductive Health Services

Family planning and other reproductive health programs can  play a significant role in addressing the HIV prevention and care needs of women. Such programs already reach millions of women with reproductive health services and, thus, provide an ideal opportunity to address women’s broader sexual health needs. For many women, family planning and prenatal care visits are their only contact with the health care system and their only opportunity to receive information about prevention and the potential impact of HIV and other sexually transmitted infections (STIs) on their health.

Given the extent of the HIV epidemic and the rapid growth in the general population, it is important for health care providers to take advantage of all opportunities to communicate prevention messages and to provide services that address the specific needs of HIV-positive women. When providers address HIV within reproductive health services, clients can access a broader range of services and the quality of existing services can be improved. Clients will be more satisfied as their broader needs and concerns are addressed, and services can be more efficient since multiple, interrelated needs are addressed in a single visit.

The integration of HIV/STI prevention into family planning counseling can be considered a key aspect of informed choice. A woman cannot make a fully informed choice of a family planning method if she does not understand her risks of HIV/STI transmission and the degree to which her chosen method does or does not protect her. Providers, therefore, have an obligation to provide information on whether various contraceptive methods protect against HIV and other STIs.

Simply providing information about transmission and risks, however, is insufficient. Successful integrated counseling also takes into account clients’ sexual lives, individual circumstances, and the social context in which they make decisions. Integrated counseling helps clients to:

• Make informed, realistic, and achievable sexual and reproductive health decisions
• Explore and assess their own risk of infection, and initiate preventive health behaviors
• Negotiate safer sexual behaviors, and prevent infection
• Make treatment choices that meet their personal and sexual health needs
• Clarify concerns related to sexuality
• Improve their sexual and reproductive health knowledge, and promote sharing of that information

Human rights and informed choice

Stigma and discrimination against people living with HIV/AIDS (PLHA) continue to undermine the efforts to curb the pandemic. Unfortunately, PLHA often continue to experience stigma and discrimination at home, in their community, in educational settings, in the workplace, in the military, as well as in health care settings.

This course endorses and applies the fundamental concept that an environment in which human rights are affirmed and respected is essential to reducing vulnerability to HIV/AIDS. In order to help service providers implement a human rights-based strategy in their work, this course uses an informed choice approach. This emphasizes the right of individuals to make informed decisions about their health that are free from discrimination, coercion, and violence.

Linkages to STIs

One particularly important factor for reproductive health care providers to consider in efforts to reduce HIV risk for their clients has to do with the relationship between HIV and other STIs.

STI treatment and prevention can be an important tool in limiting the spread of HIV infection since:

• A person infected with an STI has a much higher risk of acquiring HIV from an infected partner.
• A person infected with both HIV and another STI has a higher risk of transmitting HIV to another partner.

For example, it is estimated that the presence of an ulcerative STI (such as herpes, syphilis, or chancroid) increases the risk of HIV acquisition from 10 to 300 times per exposure, while the presence of a nonulcerative STI (such as gonorrhea or chlamydia) increases the risk from 3 to 10 times per exposure.

Although HIV can pass more easily through genital ulcers, STIs that do not cause ulcers also increase risk. This is because they increase the number of white blood cells (which have receptor sites for HIV) in the genital tract and because genital inflammation may cause microscopic lesions that can allow HIV to enter the body.

The “shedding” of HIV in genital fluids is increased by the inflammation related to STIs, making those who are infected with both HIV and other STIs even more infective (i.e., capable of infecting others). Studies have shown that treating STIs in men reduces the amount of HIV found in their ejaculate.

In addition, HIV infection may complicate the diagnosis and treatment of other STIs because HIV may change the patterns of disease or clinical manifestations of certain infections.  In people with HIV infection, STI symptoms may be more severe, the period of infectivity may be increased, and normal treatments may fail.

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