HIV diagnosis and sexual risk behavior intentions among couple VCT clients in Ethiopia.

This research examines whether members of HIV affected couples are more likely to change their abstinence and condom intentions than members of HIV- couples during couple voluntary counseling and testing (VCT). A total of 1260 couple VCT clients in Ethiopia were asked about their sexual risk behavior intentions for the next two months after pre-test and post-test counseling. Multinomial logistic regression was used to determine whether the couple's HIV status was associated with changed intentions to abstain or use condoms between pre-test and post-test. Individuals belonging to male HIV+ serodiscordant couples (aRRR = 7.98, p < 0.001), female HIV+ serodiscordant couples (aRRR = 5.85, p < 0.001), and HIV+ concordant couples (aRRR = 3.12, p = 0.05) were more likely to have increased their intentions to abstain or use condoms in the next two months than individuals in HIV- concordant relationships. The couple's HIV status was not associated with decreased intentions to abstain or use condoms in the next two months. Counseling for all HIV affected couples should include practical information on obtaining and using condoms. This includes HIV affected couples who intend to abstain from sex, whether for a short or long period of time, so that they are prepared to have protected sex if their intentions change.

Couple VCT clients in Ethiopia: a heterogeneous HIV risk group.

Studies show reduced HIV risk behaviors after couple voluntary counseling and testing (VCT), either resulting from the couple counseling process or the type of people it attracts. A total of 1858 sexually active individual VCT clients in partnerships were compared to 866 sexually experienced couple VCT participants with multilevel logistic regression. Sexually experienced couple VCT clients were also compared to those couple VCT clients who never had sex. Among sexually experienced participants in partnerships, women, non-premarital testers, and those who felt at risk for HIV were less likely to attend couple VCT than individual VCT. Among couple VCT clients, sexually inexperienced individuals were more likely to be: testing for the first time, premarital testers, and more educated than those who were sexually experienced. Couple VCT's effectiveness might partly result from who it attracts. Addressing the diverse needs of a heterogeneous testing population is a programmatic challenge for couple VCT in Ethiopia.

HIV diagnosis and fertility intentions among couple VCT clients in Ethiopia.

In Ethiopia, most HIV-affected couples are in serodiscordant relationships and must weigh any childbearing desires against the risk of transmitting the virus to a partner or child. This analysis investigates the relationship between HIV diagnosis and fertility intentions among couple voluntary counseling and testing (VCT) clients in Ethiopia and whether this relationship differs between men and women. Data come from the Ethiopia Voluntary Counseling and Testing Integrated with Contraceptive Services (VICS) study, which collected information from men and women attending VCT at eight public sector health facilities in the Oromia region of Ethiopia. VCT clients were asked about their fertility intentions before (pre-test) and after (post-test) receiving their HIV test results. Sex-stratified logistic regression was used to find characteristics, such as the couple's HIV status, associated with ceasing to desire children between pre-test and post-test versus desiring children at both time points. Women belonging to serodiscordant couples were much more likely to cease desiring children than women in HIV-concordant couples, regardless of whether the woman (aOR=11.08, p<0.001) or her partner (aOR=9.97, p=0.001) was HIV+. Only HIV+ men in serodiscordant relationships were more likely to stop desiring children than men in HIV-concordant couples (aOR=12.10, p<0.001). Serodiscordant couples would benefit from family planning services or referrals during VCT to help meet their reproductive needs.

Estimating the obstetric costs of female genital mutilation in six African countries.

OBJECTIVE: To estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. METHODS: A multistate model depicted six cohorts of 100,000 15-year-old girls who survived until the age of 45 years. Cohort members were modelled to have various degrees of FGM, to undergo childbirth according to each country's mortality and fertility statistics, and to have medically attended deliveries at the frequency observed in the relevant country. The risk of obstetric complications was estimated based on a 2006 study of 28,393 women. The costs of each complication were estimated in purchasing power parity dollars (I$) for 2008 and discounted at 3%. The model also tracked life years lost owing to fatal obstetric haemorrhage. Multivariate sensitivity analysis was used to estimate the uncertainty around the findings. FINDINGS: The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15-45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130,000 life years is expected owing to FGM's association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. CONCLUSION: Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications.

Providing family planning in Ethiopian voluntary HIV counseling and testing facilities: client, counselor and facility-level considerations.

BACKGROUND: Governments and donors encourage the integration of family planning into voluntary HIV counseling and testing (VCT) services. We aimed to determine whether VCT counselors could feasibly offer family planning and whether clients would accept such services. DESIGN AND METHODS: We employed a quasi-experimental, pre and postintervention survey design, interviewing 4019 VCT clients attending eight Ethiopian public sector facilities and 4027 additional clients 18 months after introducing family planning services in the same facilities. We constructed sex-stratified multilevel models assessing three outcomes: whether clients received contraceptive counseling, whether clients obtained contraceptive methods during VCT and whether clients intended to use condoms consistently after VCT. RESULTS: Clients demonstrated lower than expected immediate need for contraception. After intervention, only 29% of women had sex in the past 30 days, and 74% of these women were already using contraceptives. Despite the relatively low risk this population had for unwanted pregnancy, family planning counseling in VCT increased from 2 to 41% for women and from 3 to 29% for men (P < 0.01). Approximately, 6% of clients received contraceptive methods. However, sexually active men and women and those with more perceived HIV risk were more likely to obtain contraceptives and intend to use condoms consistently. Men attending facilities with higher client loads were 88% less likely to receive family planning information and 93% less likely to receive contraceptives than those attending facilities with lower client loads. Male and female clients whose counselors perceived contraceptive availability to be adequate were four and two times more likely, respectively, to receive contraceptive methods than those counseled by providers who felt supplies were inadequate (P < 0.01). CONCLUSION: Integrating VCT and family planning services is likely to be an effective programmatic option, but populations at risk for HIV or unintended pregnancy should be targeted.