Delivering family planning services in the era of AIDS / STDs.

AIDS and sexually transmitted diseases (STDs) pose several challenges for the delivery of family planning services but family planning programs can pay a key role in AIDS/STD prevention. Oral contraceptives (OCs) may place women at increased risk of STDs and HIV. Yet some research suggests that OCs thicken the cervical mucus thereby decreasing the risk. It is not yet clear whether IUDs increase the risk of acquiring STDs an HIV. Injectables and implants may also put women at greater risk since they change bleeding patterns and the needles or sharp instruments may not be sterile. Considerable research shows that condoms protect against STD and HIV transmission but condom use is relatively low. Some obstacles to condom use include insufficient supply womens low status and difficulty in discussing sexuality. Still condom demand worldwide is up because of the AIDS epidemic. Managers can adopt effective logistic distribution and storage systems for condoms. The female condom is now available in Europe and soon will be in the US. Spermicides can destroy HIV in vitro but it is not yet clear whether they can in vivo. Family planning and health providers must implement infection control measures to protect themselves and clients. These measures are rubber gloves gowns goggles and proper sterilization equipment. Since family planning providers have traditionally counseled clients it should be relatively easy for them to incorporate HIV/STD prevention messages or to counsel HIV-positive women on how not to transmit HIV to others. During counseling sessions they can assess a clients HIV risk through a questionnaire or self-assessment. They must realize that it is difficult for clients to change behavior because often women are powerless or for cultural reasons unwilling to do so. Screening all women of reproductive age for HIV is impractical and costly.