Promoting dual protection in family planning clinics in Ibadan, Nigeria

CONTEXT: Integration of efforts to prevent HIV and sexually transmitted infections (STIs) and of condom promotion into family planning services is urgently needed because of the escalating HIV epidemic in Sub-Saharan Africa. METHODS: Counseling on dual protection-concurrent protection from unintended pregnancy and HIV and other STIs-and provision of the female condom were introduced in six family planning clinics in Ibadan, Nigeria. Structured observations of interactions between clients and service providers, clinic service statistics, provider interviews, and other qualitative and quantitative methods were used to assess family planning providers' promotion of dual protection. RESULTS: Following intensive training, providers delivered dual-protection counseling to a majority of clients and demonstrated the female condom to 80916 of the new clients observed. Discussion of the sexual behavior of clients and their partners, of the relative ability of various contraceptives to protect against HIV infection and of how to negotiate condom use increased significantly, as did STI assessment. Providers' internalization of the importance of HIV/AIDS prevention was crucial to promoting and sustaining the dual-protection initiative. Condom purchases increased from a baseline of 2% of all family planning visits in 1999 to 9% in January-June 2001. This increase came mainly from acceptance of the female condom, used either alone or in conjunction with another contraceptive. CONCLUSIONS: Integrating dual-protection counseling and female condom provision into family planning services appears feasible, as Is service providers' acceptance of dual-protection objectives. While providers and clients are key to transforming family planning to dual-protection services, the attitudes and behaviors of clients' male partners must be considered in gauging the success of the dual-protection intervention.