In most settings throughout the world, family planning services and HIV services traditionally have operated separately with little or no integration. Family planning services primarily target married women of reproductive age. HIV services primarily target individuals at high risk of HIV infection. Integrating family planning and HIV services potentially can maximize the use of existing services and minimize the number of people who do not obtain the health care they need. But much remains unknown about how best to integrate services and what impact such integration will have on reproductive health outcomes, such as preventing HIV infection and unintended pregnancy. This issue of Network, an overview of current thinking about integration, is the first of a series of publications, supported by the U.S. Agency for International Development, intended to encourage health professionals to ask questions or share their experiences in regard to service integration.
In this issue
Letter from the Editor 
This issue of Network is the first of a series of publications dedicated to the topic of integrating family planning and HIV services. The collaborative effort — supported by the U.S. Agency for International Development (USAID) — aims to address the field's needs for information on integration, taking advantage of the diverse knowledge, perspectives, and program experience of USAID-supported cooperating agencies. To that end, readers are invited to contribute to this ongoing discussion.
Family Planning and HIV Service Integration
Family planning and HIV service integration holds the potential for helping women and other people — such as men, youth, and couples — prevent unintended pregnancy and HIV infection. The most successful experiences with integration to date suggest that this approach enables providers to offer more convenient, comprehensive services. Integration is also expected to expand access to services and make them more cost-effective. However, whether integration makes sense depends on the nature of the HIV epidemic and need for contraceptive services in particular settings, as described in To Integrate or Not to Integrate? Where services are integrated, some HIV services are usually provided through family planning programs, described in HIV Services for Family Planning Clients. But many types of integration are possible, and the Potential Benefits and Challenges of Integration in various ways must be considered. What Is Integration? is a reminder that service integration may also occur outside of clinical settings.
Integrating Family Planning into VCT Services
As efforts begin to shift toward integrating family planning into HIV/AIDS services, voluntary counseling and testing (VCT) centers are emerging as a primary target for integration. Research from Africa and the Caribbean shows that such integration is feasible and acceptable, and large-scale integration efforts are being launched and expanded there. However, decisions about whether to integrate need to be made at the facility level and, even then, operational challenges can impede the process, as described in Challenges to Providing Family Planning Services. Four potential levels of integration, each contingent on available resources at particular facilities, are described in Adding Family Planning to Existing VCT: Levels of Integration in Kenya. Two Web resources (1, 2) direct readers to additional information about the assessment of VCT centers in Kenya and about VCT for youth.
Case Studies
These case studies illustrate four efforts under way to integrate family planning and HIV services. Uganda: Integrating Family Planning into VCT describes how the AIDS Information Centre (AIC) in Uganda overcame various obstacles to integration. A Web resource directs readers to further information about the AIC. Why and how the Reproductive Health Association of Cambodia integrated VCT services into its clinics is highlighted in Cambodia: Clients Find Everything They Need in One Place. Expansion of the roles of Zimbabwe's community-based distributors to include HIV prevention information and referrals for HIV services is featured in Zimbabwe: 'I Have the Knowledge and Skills to Help.' Finally, research to identify changes needed to integrate family planning and HIV services throughout a health care system in Jamaica is described in Jamaica: System-Wide Integration of Services.
Averting HIV-Infected Births
An alarming number of new HIV infections are occurring among children, the vast majority of whom were infected by their mothers. To date, funding for developing countries has primarily supported an approach of providing voluntary counseling and testing (VCT) for HIV during pregnancy and then a short course of antiretroviral (ARV) drug therapy to HIV-infected pregnant women and their newborns. This is to prevent HIV transmission from mother to infant during delivery. Another approach is to provide care and support to women, infants and families infected and affected by HIV/AIDS. But minimizing HIV-infected births will likely be best achieved through a combination of approaches that includes Preventing Pregnancy Among HIV-infected Women and preventing HIV infection among reproductive-age women (Preventing HIV Infection among Pregnant Women). In both of these latter scenarios, family planning services can play an essential role in the prevention of mother-to-child transmission (PMTCT) of HIV. Although many operational challenges have not yet been explored in depth and the feasibility of such integration is largely unknown, policy guidelines indicate increasing support for the integration of family planning services to achieve PMTCT goals. And three recent analyses suggest that family planning services can both have a marked impact on averting HIV-infected births, as described in Family Planning: Considerable Impact at Relatively Low Cost. A Web resource directs readers to a literature review about family planning and PMTCT.
Involving Men
Reproductive health experts have long recognized that involving men in family planning yields such benefits as client satisfaction and the adoption, continuation, and effectiveness of contraceptive use. But it has also become clear that the cooperation of male partners is necessary for women to act on HIV-prevention messages delivered through integrated services. This article describes efforts to involve men in protecting reproductive health, with an emphasis on projects designed to change gender norms. Assessing Men's Attitudes About Gender Roles describes how use of a new tool for evaluating men attitudes about gender roles is helping to clarify whether more egalitarian attitudes are associated with behaviors that reduce reproductive health risks. Integrating Services to Appeal to Men highlights how various organizations are reaching men by addressing their concerns about a variety of sexual and reproductive health issues.
