Addressing institutional and cultural obstacles to the provision of a gender-sensitive contraceptive counselling for people living with HIV

GOGNA, MONICA; PECHENY, MARIO; MANZELLI, HERNÁN; IBARLUCÍA, INÉS; BARRÓN LÓPEZ, SARA

México, D.F., México

Conferencia; XVII International AIDS Conference; 2008

International AIDS Conference

Background: The paper analyzes to what extent and how are the contraceptive needs and rights of people living with HIV being acknowledged and fulfilled in Argentina from the perspectives of both health care users and service managers/providers. Methods: The paper builds on the findings of: a) A qualitative research jointly developed by CEDES and the Buenos Aires AIDS Coordination. b) A national quantitative-qualitative study that included a survey amongst men and women living with HIV (N=841) and 49 semi-structured interviews with female and male NGO representatives and health providers/HIV-AIDS program coordinators (Pecheny and Manzelli, 2006). Results: 55 percent of women and 30 percent of men had had children after their HIV diagnosis. Half of those pregnancies had been unintended, thus revealing an unmet need for contraception. At the time of the survey, 73 percent of men and 64 percent of women didn’t want a (new) pregnancy. Double protection is not encouraged by the vast majority of physicians, who only recommend condoms to prevent infections or re-infections and unwanted pregnancies. Only one out of ten people interviewed who risk an unwanted pregnancy use condom plus another birth-control method. Professionals´ lack of updated information about interactions between antiretroviral drugs and contraceptive methods and inefficient referral among infectious diseases specialists and family planning providers were the main problems identified. Physicians´ "gender incompetence" and lack of abilities to address sexuality-related issues also hindered an adequate response to users’ contraceptive needs. Conclusions: Physicians´ knowledge regarding HIV and contraception needs to be updated (when necessary) in trainings that also provide them with a gender and rights perspective. Interdisciplinary approaches to contraceptive counselling and the incorporation of people living with HIV as counsellors are also key strategies to enhance service efficacy as well and the fulfilment of sexual and reproductive rights.