Janet Fleischman
Senior Associate, Global Health Policy Center
With all the troubling political news coming out of Kenya these days, it’s important to highlight some promising initiatives that are under way in the arena of women’s health, often driven by civil society groups or international NGOs in collaboration with the government. One area where such initiatives are getting some traction involves the bi-directional integration of family planning/reproductive health with HIV/AIDS services. Indeed, the new approaches toward broader integration hold the promise of helping to address both the country’s HIV/AIDS crisis and women’s reproductive health needs, including addressing the huge unmet need for family planning.
The importance of this approach is starkly revealed in the recently published Kenya AIDS Indicator Survey (KAIS), produced by the Kenyan government with technical and financial support from the U.S. government. The report found that women were more likely to be HIV-infected (8.4%) than men (5.4%), and that young women were 4 times more likely to be infected than boys their age. Among women of reproductive age (15-49), the report found that 70.5% wanted to delay pregnancy for at least two years or did not want a child, but less than half reported using modern contraception. The situation is particularly critical among HIV-infected women – 66.8% reported wanting to delay pregnancy for at least two years, yet just over 40% of these women used modern contraception. On top of all this, the percentage of Kenyans who know their HIV status remains low throughout the country.
On a recent trip to Kenya, I visited a number of health clinics in Coast Province, many supported by the AIDS Population and Health Integrated Assistance program (APHIA II), funded by USAID and PEPFAR, where Family Health International leads a consortium. These clinics are working to expand the entry points for access to ensure that wherever women enter the health system, they are able to receive the broader services they need. This means, for example, that a woman entering a Comprehensive Care Center (CCC) at Malindi District Hospital for her HIV/AIDS treatment services, will also have access to information about family planning and access to a range of contraceptive methods, as well as screening for cervical cancer –- a critical problem for HIV-infected women – post rape care, and treatment for sexually transmitted infections. At the same time, women seeking services at the family planning or antenatal clinics will be given information about HIV testing and prevention of mother-to-child transmission (PMTCT), and offered on-site tests. Similarly, young women visiting the youth friendly clinic at the hospital, or the youth clinic in Mombasa run by Family Health Options Kenya, are offered information about the range of HIV and reproductive health services.
These kinds of integrated programs represent critical ways to expand women’s access to both HIV and reproductive health information and services. Yet expanding these services and increasing the numbers of Kenyans who know their HIV status is only part of what needs to be done. In addition to addressing the significant human and financial resources required to roll out and sustain these services, there is also a need to go beyond the numbers and identify the barriers that women and girls face in accessing services in the first place. In a context where women are often marginalized economically, find themselves married or pregnant as teenagers, and face risks of gender-based violence, HIV programs must be encouraged to develop innovative ways to address these issues in a more comprehensive and integrated environment.