Understanding the Dynamics of HIV/AIDS and Family Planning at the Community Level in Zambia

Introduction

"In the midst of an HIV and AIDS epidemic that is characterized predominantly by heterosexual transmission, individuals of reproductive age in Zambia make fertility-related decisions in an environment much more complex than in previous generations. It is vital for health communicators to understand how HIV-positive status and high prevalence, regardless of one’s status, influence fertility-related decisions so as to more fully address the public’s reproductive health concerns.

HIV prevalence in Zambia remains high.... This report examines the role of HIV and AIDS in fertility decision-making, changing social norms about child-bearing, and contraceptive use; and it explores the role of communication in that process. While research has shown that social norms often discourage HIV-infected people from having children, many people living with HIV and AIDS desire and expect to have children.... When one or both partners are infected, individual factors in tandem with social ones influence fertility decisions. A recent article in the Lancet (Myer, Morroni, & El-Sadr, 2005) called for more research to understand the factors that influence HIV-infected women’s reproductive decisions. The study discussed herein also explores the impact on men’s reproductive decisions."


Recommendations include the following:

• Take care of the basics of family planning and HIV communication - (1) discuss family planning in a comprehensive way that addresses misconceptions; (2) tackle stigma; (3) pursue gender programming that empowers women to bring issues up without retaliation; and (4) promote preventing mother-to-child transmission (PMTCT) programmes, among others.
• Gender is a central, not a peripheral issue in integration, particularly as it impacts partners' sharing of test results.
• Intensify programmes for male involvement in reproductive health matters - recognise men’s responsibilities by encouraging them to get tested, to use condoms consistently, and to participate in couple counselling about HIV/AIDS and family planning.
• Promote spousal communication - through communication modelling and role play, couples can be encouraged to discuss the constellation of issues that connect HIV/AIDS and family planning.
• Deepen family planning communication - the economic and health rationales for family planning still resonate with people and should be discussed in that context, while addressing address rumours and misconceptions about HIV and promoting correct and consistent use of condoms. HIV-positive women should be offered other contraceptives. Communication on family planning should include encouraging people to take action for the benefit of children and the family. The study showed that this may resonate more strongly with couples than individually focused justifications for behaviour change.
• Refine voluntary counselling and testing (VCT), encourage couples’ counselling and testing, and embark on campaigns for mass voluntary counselling and testing - family planning is not discussed seriously within the VCT context. Also, clients are neither adequately prepared for the implications of their results nor counselled adequately post-test regarding issues such as breastfeeding, family planning, fertility, couple communication, stigma, and the efficacy of anit-retroviral drugs (ARVs).
• Refine treatment communication -include availability of ARVs, the realistic extent of that availability, and the effectiveness of the medications.
• Devise clear messages about childbearing when the mother is HIV positive.
• Properly communicate PMTCT, including information about breastfeeding when HIV-positive - the public should be given correct information so they can make their decisions based on realistic assessments. HIV-positive women should be told that the chances of transmitting the virus to their infant during birth or breastfeeding are one in three, one in six, or the results of the most recent research. Conditions fro safe breastfeeding need to be clear.
• Create a compassion movement - encourage the formation of, and, where these exist, support the operations and activities of, community-based groups. Community groups are important in enhancing the process of community engagement, which is essential in bringing about environmental and behavioural changes that will change social norms, thus improving the health of the community and its members.
• Emphasise trusted friends and relatives - because support and solace from close relatives and friends is present and valued, communication programmes should take advantage of this point of support amidst the stigma by, for instance, counselling the circle of friends along with the individual living with HIV/AIDS, both in post-test interactions with the provider and in post-test clubs. Model that behaviour in the mass media by showing that there is someone there who can be trusted to provide support and sympathy.