One approach that may work better is to integrate
different health services. Integration of services allows clients to receive
more services in a single visit. Variations of integration models mean that
some services are provided by the same health care worker, or in the same
consulting room or at the same facility. In general, integration of services is
expected to produce benefits for both clients and service providers through
improvements in the quality, uptake and efficiency of services [5,6].
Reviews synthesizing the evidence-base of SRH and HIV
service integration identified studies primarily from low-income settings and
found largely positive results across various outcome indicators including:
increases in uptake of HIV testing, reduction in STI incidence, increases in
condom use and improvements in quality of care [7-10], although a lack of
vigorous evaluation and analysis that accounts for confounders reduces the
possibility to draw firm conclusions. Many evaluations focus on female-orientated
facilities or departments, such as family planning, ante or post-natal care, or
maternal and child care which have little relevance for men. A consistent
finding in different settings was that of substantial missed opportunities by
service providers to address other SRH issues when clients present to clinics.
As part of the Integra Initiative
(www.integrainitiative.org), different models of service delivery for integrated
SRH and HIV services are being evaluated. Two rounds of cross-sectional
household surveys have been conducted in Kenya and Swaziland. These will be analyzed
to explore changes in service uptake among men and women as well as changes in
the levels of demand for integrated services. It is anticipated that these
findings will contribute to our limited knowledge about whether integrated
services can improve men’s and women’s uptake of SRH services.
References listed in the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys
The
potential to enhance male involvement in HIV services - an example from
Swaziland
By Joshua
Kikuvi, Fieldwork Coordinator, Swaziland (Integra Initiative)
At one of the Integra Initiative sites in Swaziland
(King Sobhuza II Public Health Unit), there exists the potential of increasing
men’s access to HIV services in a high HIV prevalence setting. The facility is located
on the outskirts of an urban industrial zone, and offers both maternal and
child health (MCH) services as well as dental, STI and dermatological services.
All clients presenting themselves for any of these services are asked to state
their HIV status (if known). Regardless of their status, basic HIV and STI
counselling is offered to all clients before referral to the ART department for
more comprehensive counselling (and testing, if the client consents).
Although the facility caters predominantly to women
and children, there is a huge potential to use these services to create
linkages that strengthen integration of HIV services with other curative and
preventive services. These can be creatively tailored to promote male
involvement in say, family planning and couples testing in such service
packages as antenatal care, prevention of mother to child transmission and antiretroviral
treatment, so that when women use these services, they also encourage their
partners to seek healthcare. These baby steps towards integration of HIV and
other services could improve men’s access to sexual reproductive health and HIV
services.
