Meeting the Contraceptive Needs of Key Populations Affected by HIV in Asia: An Unfinished Agenda

Abstract

Like all women, women living with and at risk of acquiring HIV have the right to determine the number and timing of their pregnancies and to safely achieve their reproductive intentions. Yet, many women in Asia affected by HIV lack access to family planning services and experience disproportionately high rates of unintended pregnancy and abortion. Programs that have succeeded in promoting condom use and providing HIV prevention and treatment services in this region have largely missed the opportunity to address the contraceptive needs of the key populations they serve. The importance of better linkages between family planning and HIV policies and programs is now widely recognized by global health policymakers and donors. However, to date, most of the efforts to improve these linkages have been conducted in Africa. Greater attention is needed to the developing, implementing, and evaluating of integrated family planning/HIV approaches that are tailored to the political, cultural, and public health context in Asia. In this paper, we describe the use of and need for family planning among key populations affected by HIV in Asia, discuss the challenges to effectively addressing of these needs, and offer recommendations for strengthening the linkages between family planning and HIV policies and programs in the region.

Understanding the Broader Sexual and Reproductive Health Needs of Female Sex Workers in Dhaka, Bangladesh

“…8 While promotion of methods other than condoms is often a concern in HIV programs, the evidence suggests that individuals at high risk for HIV do not substitute other methods for condoms. 2,8,25 Our data clearly show that female sex workers recognize the need for condoms for disease prevention, regardless of whether they are using another contraceptive method. Female sex workers need a wide range of reproductive health services, and participants in our study relied primarily on the private sector (including drug shops) and NGOs when they sought care.…”

“…Among women who had visited a provider, the service most often used was STI testing and treatment (77-81% of women in the two groups), followed by maternal and child health services (32-53%) and treatment for injuries related to violence it may be tempting to try to meet all of the sexual and reproductive health service needs of female sex workers at a single site, we must bear in mind that integration can present logistical and other challenges, such as ensuring adequate staffing, training and space and maintaining quality of services. 2,5 One pressing need that stands out is that for services and interventions that address gender-based violence. Levels of such violence are high in Bangladeshi society in general, and are particularly high among female sex workers.…”

“…[1][2][3][4] Stigma and discrimination, as well as policy and access challenges, discourage female sex workers from using traditional clinic-based services, which has led to alternative models of service delivery that specifically target this population. 2,5 These services, however, generally focus on prevention, care and treatment of HIV and other STIs; this means that many of female sex workers' reproductive health needs, including family planning, are frequently neglected. Although HIV programs promote condom use as a means of preventing STIs, prevention of unintended pregnancy often is not a primary concern.…”

“…Although HIV programs promote condom use as a means of preventing STIs, prevention of unintended pregnancy often is not a primary concern. 2,6 If used consistently, condoms protect against both HIV and pregnancy; however, despite reports of widespread condom use among female sex workers, evidence indicates that such use is inconsistent. Female sex workers may use condoms inconsistently because they lack the autonomy to insist on condom use with husbands, boyfriends or other steady partners, agree to have condomless sex with clients who will pay extra, are unable to negotiate condom use with clients and or are forced to have sex.…”

Fertility-related research needs among women at the margins

“…[140][141][142] High rates of abortion have been reported among women who use drugs, some of whom are also sex workers, however, reduction in abortion-related risks and integration of family planning and post-abortion care in this population has not adequately been documented. [143][144][145] Fertility-related assessments prior to pregnancy in this population are limited, although studies focused on women living with HIV in Canada, including women who use drugs, suggested that drug use did not affect fertility intentions. 146 Evidence-based and human rightsaffirming interventions are needed at this time when certain programming efforts incentivize contraceptive use or sterilization among women who use drugs.…”