Admire Chirowodza A0 posterFH11 by monkey6


Admire Chirowodza A0 posterFH11

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Zipho Phakathi1, Heidi van Rooyen1, Nuala McGrath1,2, Admire Chirowodza1, Merridy Boettiger1 and Victoria Hosegood1,2 1 Human Sciences Research Council 2 London School of Hygience and Tropical Medicine BACKGROUND Most new HIV infections in sub-Saharan Africa are acquired from cohabiting heterosexual partners (Allen et al., 2007). Addressing HIV risk at the level of the couple has potential for reducing new infections and could contribute to prevention efforts. Few studies exist that shed light on how reproductive health, family planning and HIV prevention may be integrated to ensure comprehensive health services for couples in these contexts. STUDY AIM To report on the preliminary findings of a pilot study in KwaZulu Natal that sought to understand the reproductive health, family planning and HIV prevention needs of couples in a rural community. METHODOLOGY Two groups of participants were recruited: 12 couples were recruited from Project Accept intervention venues. Project Accept is an ongoing intervention trial testing the efficacy of a community based voluntary counseling and testing (VCT) intervention. 12 couples were recruited from various community venues outside of the Project Accept intervention. In addition, various community stakeholders were recruited as Key Informants (12). In-depth interviews were conducted with both individuals of a couple, as well as with couples jointly. Individual and joint couples interviews were conducted either in the couple’s household or at study offices. Individual couple interviews ranged from 45-60 minutes. Joint couple interviews ranged from 20-30 minutes per interview. All Key Informants interviews were conducted in the participant’s homes. Key Informants interviews ranged from 1 hour to 1 hour 30 minutes. DATA ANALYSIS Interviews were transcribed and translated. Sections of the text that referred to couples reproductive health, family planning, and HIV prevention experiences and needs were identified and coded. Transcripts were reviewed with a view to noting emerging themes, as well as identifying similarities and differences across the individual and couples data. For this preliminary analysis, 15 individual couples interviews, 9 joint couples interviews and 5 key informants interviews were analyzed since data processing (transcribing and translating) was still in progress. PRELIMINARY FINDINGS
Characteristics of couples interviewed
I: Okay in other words you have never found a chance to go? we just have never found eh a chance to go Okay Yes but it is indeed something that is in your plans in the plan both of you? Yes to go together

P: I: P: I: P: I: P:


Male participant -- CS-012

Couples noted that although some male partners do accompany their female partners to access services of reproductive health, they don’t really know what’s happening inside. Couples reported that men rely on their partners to tell them about their reproductive health related issues. Couples reported that reproductive health and family planning discussions emerged between couples more in times of ill health, rather than as something that is discussed proactively. With regard to types of services offered for family planning in a clinic setting, female participants expressed their concern on the reliability of the injection in preventing pregnancy and also had various concerns about side effects.

As with reproductive health services, couples reported that people don’t go as a couple for HIV testing and other HIV related services, rather they do it individually. Couples also expressed that females are the ones who are getting HIV testing and education the most, because they use clinics and hospitals most of the time. Couples expressed that community based services that operate outside health institutions are needed in order to access couples for HIV/AIDS and reproductive health related services.

CASE STUDY 2 (Couple ID: 082) The couple have been together for about 10 years. Although the couple are not yet married, they are preparing to get married. The couple do not live together. The male partner stays with his family. The female partner stays with her family at her household. They have four children together-two pairs of twins, while his partner has a child from a previous relationship Work status of couple is unknown. Extract: HIV/AIDS [Joint Couple Interview: "Community based services are required if we are to access couples for HIV/AIDS issues in the community"]

The average relationship length of couples was 3.9 years. The average proportion of couples living together was 8.33% (2 of 24 couples interviewed). In interviews with couples, men and women said that family planning is a service for women only. However many men expressed an interest in being involved in the family planning process and often asked their partners details of their visit to the clinic. Despite men’s stated interest in being involved with family planning decisions, none of the men attended clinics with their partners. Participants’ reasons for men not accompanying their partners to access reproductive health and family planning services in the community health centres included: Lack of time because of work commitments. The perception that current health facilities are women centered/focused. Non cohabitation of partners, as it is frowned upon in the community to stay with your partner without formally getting married. Distance then becomes a barrier for men to support their partners.

Reproductive Health & Family Planning

CASE STUDY 1 (Couple ID: 012) The couple have been together for more than 6 years. They are unmarried, but are in a committed relationship and are planning to get married soon. The couple lives apart. The female partner lives in Hammarsdale with her family. The male partner lives in Vulindlela, which is approximately 45 kms away from Hammarsdale. The female partner visits and stays for a long period at a time. The male partner is currently employed but the female partner’s employment status is unknown. The couple have three children together. Extract: Reproductive Health & Family Planning [Individual Couple Interview: “Reasons for men not accompanying their partners to access reproductive health and family planning services at clinics”]

Okay may be a program where couples go a place to talk about the topics we discussed that of reproductive health, that of relationships and also HIV eh can they appreciate it may be? Awu a lot, a lot, in a way that in order to get people in their majority in the community there are prog…, they have their structures I: Uhm P: which are known a person who is listened to when they are talking I: Uhum P: I think that a person of that caliber it is important that as NGOs or yes I can say so you can be able to use that person so that they can bring people to be closer in their big numbers I: Yes P: and then there is that a brave person has to be found who will be able to say this thing who is an orator who will put it in a manner I: Uhum P2: they do not like to involve themselves much with the community activities so just it can be a bit difficult but then just end up I think that it can…, they can be able…, they can be able they can end up understanding because one may be two who can be serious about that I: Uhm P2: I think it can end up…, I: Okay if then there was a program of this sort which place can be appropriate especially the couples…especially for couples to come to the program, the Edendale hospital or a community based organisation, where can it be may be where it can be easy for people may be to may be for this program? P2: a community based organisation I: Uhum P: Yes I think that I think that there is a certain program as the…, when we talk may be as you say you are working at Vulindlela I: Uhum P: which you know that it is a neutral place if you are going to assemble people from a certain esigodini, a certain isigodi and an area I: Uhm P: we can be able when we are gathered here it means everyone who stays in this area can be likely to come in their majority I: Uhm P: also if we are gathered here you see just the points do you know points are able to bring together people of this isigodi together I: Uhm P: may be I think it's that type of an approach we can be able to work I: So, be done by the organization in the community which is based in the community? P: which is based in the community because it is the one which has the information that we have a program which we based that okay in this area we work like this Joint couple interview-CS 082 P:


CHALLENGES It was very difficult to recruit couples to participate in this pilot study. This is due to a number of reasons including lack of time to participate (the study required 3 interviews in total per couple), and logistical difficulties with competing work commitments and couples not living together. CONCLUSION There is a demand for couples’ interventions at both an institutional and community based level that focus on reproductive health, family planning and HIV related services. Most couples felt that an integrated approach would be helpful as long as it would be a community based programme or intervention, rather than situated in a clinic or hospital setting. The logistical difficulties in recruiting couples in this setting need to be taken into consideration when devising interventions that require couples to access services together. REFERENCES
Allen, S., Karita, E., Chomba, E., Roth, D., Telfair, J., Zulu, I., et al. (2007). Promotion of couples' voluntary counselling and testing for HIV through influencial networks in two African capital cities. BMC Public Health, 7, 349-354.



Okay, okay eh may be can you tell me what you have experienced when you went for family planning and reproductive health services? Eh previously when I was at work, whilst I was working so coming, I will just say regarding contraception then actually she used just to go to the clinics most of the time even when she is that side at Hammarsdale may be she will call me and tell me that she went for instance I will then ask hawu how did it go, she will say no they talked they advised her for instance they said she must tell me that I must accompany her may be so for me the problem was time then, the job that I was doing, you find that the programs are not fitting in together, you see I: Okay P: so but it was something that we did not leave hanging it just needed us to go together get there and be able to advise one another as a person we are in a relationship with I: Yes P: indeed it was not a problem

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