In Cambodia, we’re working with national partners to improve the integration of voluntary family planning and HIV services. It’s an issue that’s a top priority for the Government of Cambodia. And with funding from USAID through SIFPO, which includes PEPFAR funds, we’re making sure we’re reaching the most under-served groups.
An unmet need for family planning
While HIV infection rates are low in the general population (0.5%) in Cambodia, the picture is very different among the most at risk populations such as sex workers (referred to as entertainment workers in Cambodia) and men who have sex with men. 14.7% of entertainment workers, for example, are living with HIV.1
These groups currently have limited access to family planning information and services. To date, condoms have largely been the only contraceptive method promoted among at risk populations. And research has revealed high rates of unwanted pregnancy among women working in the sex industry.2 There’s also anecdotal evidence to suggest that healthcare providers’ biases and lack of knowledge are barriers to them offering people living with HIV and the most at risk groups a full range of family planning choices, often promoting only condoms.
Family planning and HIV programmes are complementary in their efforts to prevent HIV and unwanted pregnancies. We know that integrating these services can increase access and uptake of both components.3 What’s more, integrating family planning services and HIV programmes allows us to tailor services to the specific needs of different groups.
Paving the way forward
We want to make a lasting impact on the Cambodian health system. So, we’re implementing interventions in five districts to learn the most effective way to integrate family planning and HIV services in Cambodia.
We’ve been working closely with the National Centre for HIV/AIDS, Dermatology and STIs and the National Maternal and Child Health Centre to provide training on integration. ‘Positive Prevention’ courses have been attended by 173 health workers so far, with attendees now systematically assessing and addressing family planning needs among their HIV positive clients and entertainment workers.
We’ve also developed and implemented discussion forums with people living with HIV and those most at risk. We’re using these to highlight the benefits of dual protection, as well as to dispel myths about possible interactions between hormonal family planning methods and antiretroviral therapy.
And, we’ve teamed up with local organisations that are connected with entertainment workers such as Cambodia Women for Peace and Development and People Compassion to introduce the “condom plus” strategy. By training these healthcare providers on counselling HIV positive clients, up skilling them to ask clients waiting for antiretroviral therapy about their family planning needs, and ensuring they’re familiar with the referral pathways, we’re improving access for these groups to a full range of family planning services.
From this activity, we will gain concrete evidence and examples of interventions that are scalable, cost-effective and have the potential to benefit the broader Cambodian family planning and HIV communities, as well as having the potential for national impact.
Case study: Supporting integration at the Chey Chum Nas Referral Hospital
Dr. Kong Chunly is the Director of the Chey Chum Nas Referral Hospital in Kandal, near Phnom Penh. This year, with the support of MSI Cambodia, the hospital has started offering family planning counselling for the first time.
Dr. Chunly tells us:
MSI Cambodia and the Referral Hospital have worked well together to implement the new family planning services for their clients and specifically for women living with HIV. The project enables people living with HIV to access short term contraceptive methods on-site, but if long term contraception is desired the family planning counsellor can refer clients to the hospital’s maternity unit, using an MSI Cambodia voucher. That way the client receives services free of charge as it is supported by USAID through the MSI Cambodia grant.
Alongside this activity, we’ve been supporting a national assessment on family planning and HIV integration in partnership with the International HIV/AIDS Alliance. Not only will this help shape integration in Cambodia, but we hope these findings will guide the global effort on family planning and HIV integration in areas of concentrated epidemics.
Visit our Cambodia programme website to learn more about our work there visit
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2 A 2007 study found that a third of sex workers had had an unwanted pregnancy in the previous 12 months.
3 World Health Organization (WHO), United Nations Population Fund (UNFPA), International Planned Parenthood Federation (IPPF), Joint United Nations Programme on HIV/AIDS and University of California, San Francisco. Sexual and reproductive health and HIV/AIDS. Linkages: evidence review and recommendations, 2009.