HIV This Week

Prata N, Sreenivas A, Bellows B. Potential of dual-use policies to meet family planning and HIV prevention needs: a case study of Zimbabwe and Mozambique. J Fam Plann Reprod Health Care 2008; 34(4):219-26.

The fight against the HIV epidemic in many high-prevalence countries is a struggle to motivate culturally relevant risk reduction in general populations that have been educated to associate HIV risk with commercial sex, injection drug use, and other stigmatised behaviours. Common concurrent partnerships, which facilitate transmission of HIV in many high-prevalence countries, are only beginning to receive the attention they deserve. This has made the promotion of dual-use methods, such as condoms, for individuals who require both HIV protection and contraception very difficult. Recent research on concurrent partnerships and the implications for high HIV risk in sexually networked but sexually modest general populations is forcing another assessment of the response to HIV. In the light of the epidemic, it is important to better understand which policies will better meet HIV prevention and family planning needs. This article explores the potential of dual-use policies by examining Zimbabwe and Mozambique. Zimbabwe, with a vertically driven, stronger family planning programme predating the HIV epidemic, has not yet seen an increase in condom use to the level desired by their moderately strong HIV prevention programme - one that has adopted a primarily single-use condom policy. Mozambique, however, continues to have a much weaker family planning programme, but is witnessing a significant increase in condom use driven by their strong HIV programme - one that is further integrated with family planning content. Integration of HIV and family planning programmes has the potential to meet the need for HIV and pregnancy prevention more efficiently. By themselves, these programmes are unable to meet the need for condoms. The poorest of the poor are feeling the brunt of this inadequacy. Countries such as Zimbabwe and Mozambique have the potential to tremendously improve their efforts in increasing condom use. Prata and colleagues suggest that thoughtful and detailed integration of HIV and family planning programmes will work synergistically to reach common goals. Until a more promising method besides condoms is commercially available for protection against unintended pregnancy and sexually transmitted infections such as HIV, effective strategies must include dual-use policies as well as counselling on all available contraceptive methods so that women can maximise the benefits of mixing methods.

Editors’ note: This case study of Zimbabwe and Mozambique underscores the need for high HIV prevalence countries to move rapidly to promote dual protection to provide the most protection possible for all women from unwanted pregnancy and to address the unmet need for family planning among HIV-positive women. Positioning condoms as primarily contraceptive tools rather than disease protection devices may make condom negotiations in couples easier. Integration of family planning and HIV programmes requires national action supported by alignment of the donors that currently fund family planning and HIV programmes in parallel streams. Essential synergies will not be realised without integration.