Dual Needs: Contraceptive and Sexually Transmitted Infection Protection in Lusaka, Zambia

International Family Planning Perspectives A reproductive health approach to family planning service delivery takes a comprehensive view of individuals’ circumstances and moves beyond their contraceptive needs alone. In an environment with high rates of HIV and other sexually transmitted infections (STIs),* a reproductive health approach must therefore include some degree of integration of STI services with traditional family planning services. Before the 1994 International Conference on Population and Development in Cairo, the demographic emphasis in family planning strategies resulted in a focus on effective contraceptive methods. This focus often precluded barrier methods, which were considered less likely to be used consistently and correctly, and therefore less effective in pregnancy prevention. Although family planning services clearly provide contraceptive protection to clients, STI prevention through the use of condoms has received less attention. The dual-protection message—i.e., the promotion of the simultaneous use of two methods (the condom along with another method) or promotion of condoms alone for both pregnancy and STI prevention—needs to overcome some aspects of traditional family planning messages and providers’ negative bias toward nonmedical methods. Providing information on ways to protect against both unwanted pregnancy and STIs during a family planning consultation is an obvious first step toward integrating STI and family planning services. Integrating STI case management, however, is not as feasible as providing information alone, as these special services require additional infrastructure and provider training, which may overburden relatively new family planning programs.1 Furthermore, because laboratory facilities are rarely available in resourcepoor settings, STI diagnosis often relies on the syndromic approach, which has generally shown weak sensitivity and specificity for many STIs among women, particularly cervical infections.2 Nevertheless, few would disagree that, at a minimum, the integration of primary STI prevention into family planning programs is a feasible and desirable goal.3 Providing a dual-protection message is especially relevant in Zambia, where the HIV prevalence rate is among the highest in Sub-Saharan Africa.4 The high risk of contracting HIV is associated with such socioeconomic and cultural factors as being educated, living in an urban area and being in a polygamous union.5 Estimates of HIV prevalence among Zambian urban residents currently range from 25% to 32%, Dual Needs: Contraceptive and Sexually Transmitted Infection Protection in Lusaka, Zambia