AEGiS-14IAC: Missed opportunities for counselling to minimize the dual risk of pregnancy and STI/HIV acquisition at South African family planning clinics.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Missed opportunities for counselling to minimize the dual risk of pregnancy and STI/HIV acquisition at South African family planning clinics.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrD1237)

Smit JA, Mqhayi M, McFadyen ML, Mestry K, Morroni C, Kubeka M, Beksinska M
Reproductive Health Research Unit, University of the Witwatersrand

BACKGROUND: Modern contraceptive use is high amongst South African women and contraceptives are most often obtained at public sector primary care clinics where they are available free. This means that many sexually active women visit state clinics. Prevalence of HIV and STIs is unprecedently high in South Africa and family planning clinics offer opportunities for counselling clients about minimizing the dual risk of pregnancy and HIV/STI acquisition. This paper explores the extent to which these opportunities are taken.

METHODS: Data were collected in the year 2000 by means of 146 simulated client visits to 31 public sector health facilities in KwaZulu-Natal and Gauteng Provinces. Simulated clients presented 4 scenarios related to unprotected intercourse. Their experiences were captured immediately after each visit using a pre-designed checklist.

RESULTS: Emergency contraceptive pills were provided to 75% of the clients and 74% were counselled on the use of long term contraceptive methods. Non-barrier methods were recommended to almost half (49%) of these clients, barrier methods to 39% and dual methods (such as male condom plus injectable hormonal method) to 12%. Few (12%) were counselled about their risk of acquiring HIV/STIs and just 2% were told about the importance of watching for STI symptoms. Whilst 31% were provided with condoms and 10% were told to take condoms from the condom container in the clinic waiting room, only 5 clients were given instructions on how to use them and only 4 received a condom use demonstration.

CONCLUSIONS: While contraceptive needs were addressed, opportunities to counsel about risk of HIV/STI acquisition and appropriate long term contraceptive methods which also provide protection against HIV and STIs were rarely taken. Improving provider counselling skills aimed at reducing HIV/STIs amongst family planning clients is urgently required.

Keywords: AEGIS, Family Planning Services, Counseling, HIV Infections, Condoms, Contraception, Ambulatory Care Facilities, Contraceptive Devices, Contraception Behavior, HIV Seropositivity, Prevalence, Pregnancy, Unwanted, Pregnancy Complications, Infectious, South Africa, Pregnancy, Human, Female, Male

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TuOrD1237