Integrating services to increase men’s uptake of services

By Joelle Mak, Research Fellow (London School of Hygiene and Tropical Medicine, United Kingdom)

It is well documented that men’s use of health services in general, and sexual and reproductive health (SRH) services in particular, is much lower compared to women’s. Despite recognizing the need for male involvement in SRH, men are still engaged predominantly to improve women’s health rather than their own health and results in very little increase in men’s uptake of SRH services [3,4].

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.

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.

References listed in the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys