FP/HIV Programming in Ethiopia Endale Workalemahu (M.D., MPH) PSI/ETHIOPIA September 18, 2015

 Only 46% of sexually active young women in Ethiopia age report ever having used a modern FP method  FSWs face numerous barriers to consistent modern FP use such as lack of access, stigma and providers attitudes  Key Takeaway: HIV prevention interventions designed to reach FSWs are currently well positioned to reach these young women but often do not offer comprehensive FP services due to fragmented programming approaches. Problem

M M Peer Education Components: HIV prevention & treatment STI prevention & treatment FP methods & informed choice Life planning and vision Negotiation & relationships Savings and business skills Integrated Clinical Services: HIV counseling & testing STI screening & treatment FP counseling & referrals GBV screening & referrals TB screening & referrals Condom demonstration Facility-level interventions Community-level interventions Peer educators refer FSWs either to network clinics or to tents during clinical outreach events. As necessary, outreach clinical workers refer FSWs to network clinics. Modern FP Service Delivery: Pills Injectables Condoms Implants Emergency Contraception Modern FP services added to integrated clinical service package during clinical outreach events. Solution: Integrated Clinical Services

How? FSW Population Density Map, Metema, Amhara

 After 18 months of implementation 5,150 FSWs accessed voluntary FP services integrated with comprehensive HIV services.  20% of all FP clients were non-users prior to the visit.  The total incremental cost of adding FP services to the existing clinical package was approximately $0.92 per FP client served. Results

 Female sex workers (80%)  Young (43%)  Single (71%) Background Characteristics of Beneficiaries

Reaching FP Non-Users Non-users All Beneficiaries

Contraceptive Method Type Among Current Users and Non-Users

1.Comprehensive approach by existing HIV project simplified FP integration 2.Layering FP services on top of an existing project and collaboration with stakeholders reduced costs 3.Mapping data was key for reaching underserved key populations Lessons

 Adding modern FP services to existing HIV combination prevention programs that reach key underserved populations, can be an appropriate and cost-effective means to increasing FP access  How do we sustain the services and such integration under MULU? –Extend the reach through such low cost FP services –Community trust, leverage existing peer support structure –Continue the outreach and add FP services at the Drop in Centers (DICs) Conclusion

 PSI/USAID supports 54 Drop in Centers which have agreements/license from MOH to Provide Integrated clinical services  Equipment and commodities including FP supplies can be leveraged from existing mechanism  Trained providers Looking to the Future

Thank you!