Emphasizing dual protection messages.

Dual protection messages are being integrated into family planning counseling services, and providers are embracing the new messages, research from Nigeria shows.

Between 1999 and 2001, the nongovernmental Association for Reproductive and Family Health (ARFH) in Ibadan, Nigeria, and U.S. collaborators completed the first phase of a project to integrate HIV and sexually transmitted infection (STI) prevention into family planning services by promoting dual protection counseling among new clients in six family planning clinics. (1) ARFH conducted participatory training with 15 family planning providers on topics such as helping clients recognize their risk of HIV and other STIs, emphasizing the role of condoms in dual protection, and tailoring counseling messages to meet clients' individual needs. Providers were also encouraged to use a dual protection flip chart during counseling sessions, offer clients both female and male condoms, and distribute brochures on dual protection and male and female condom use.

Structured observations of provider-client interactions, conducted among 325 female clients before provider training and 289 female clients after training, showed that the percentage of new clients counseled on various components of dual protection increased significantly after training. Some of the most notable increases occurred in discussions on how dual protection can be achieved using either one or two methods (from 5 percent to 75 percent), how effectively various family planning methods prevent HIV and other STIs (from 7 percent to 42 percent), and how clients might convince their partners to use condoms (from 0 percent to 18 percent).

According to client exit interviews, the percentage of clients aware of the concept of dual protection also increased, from 8 percent before provider training to 50 percent after training. And while only 2 percent of family planning clients who visited the clinics in 1999 left with condoms as their only method of contraception, 6 percent who visited in 2000 left with condoms as their only method.

Other ongoing interventions to provide training that emphasizes dual protection messages include the following:

* New York-based EngenderHealth and FHI are collaborating to implement and evaluate comprehensive dual protection training in Ethiopia. EngenderHealth has developed and field-tested a training protocol--covering sexuality and gender, HIV and STI prevention, dual protection, and integrated counseling skills--and is using it to train staff at primary health care facilities in three regions of Ethiopia. FHI will soon assess the training's impact on providers' and clients' knowledge and attitudes, providers' counseling practices, and clients' use of dual protection strategies.

* With technical assistance from FHI, the Reproductive Health Research Unit (RHRU) in South Africa is implementing the National Dual Protection Strategies Program, which includes a South Africa Department of Health program to introduce the female condom into the country. (2) Training materials on dual protection, barrier methods, and how to integrate these topics into family planning counseling have been developed and used to train service delivery providers in nine provinces. The RHRU and FHI will continue to revise the training materials, supervise training, and monitor provider performance related to the new curriculum.

* In Kenya, FHI and other organizations are collaborating to train youth counselors to promote male condoms among their peers, using either a standard STI protection message or a dual protection message. Over 60 counselors have been trained in western Kenya. Using pre- and post-training surveys, FHI is assessing counselors' knowledge and attitudes about condom use, STIs, and consequences of unplanned pregnancy and STIs; whether the standard STI protection message is distinct from the dual protection message; and how well counselors are remembering the messages. (Of note, FHI views such condom promotion efforts as just one component of a more comprehensive approach to HIV/STI prevention. FHI promotes and implements what it calls an "ABC to Z" model: abstinence, be faithful to one partner, or--if "A" or "B" cannot be achieved--use condoms. These three strategies can be further complemented by a number of other effective HIV prevention approaches; that is, the "to Z" component of the "ABC to Z" model. [See article, page 3.])

REFERENCES

(1.) Adeokun L, Mantell JE, Weiss E, et al. Promoting dual protection in family planning clinics in Ibadan, Nigeria. Int Fam Plann Perspect 2002;28(2):87-95.

(2.) Family Health International. Expanding Barrier Method Strategies Program. Process Data Report. Research Triangle Park, NC: Family Health International, 2002.