Increasing support for family planning as HIV prevention: Identification of influential individuals and stakeholder perceptions

Preventing unintended pregnancies among HIV-positive women is one of four key elements of a comprehensive approach to preventing mother-to-child transmission (PMTCT) of HIV. The vast majority of PMTCT programs, however, do not operationalize this critical element. In an effort to reach key individuals whose support could improve the adoption of voluntary contraception as a strategy for HIV prevention, Family Health International is implementing an innovative project based on Malcolm Gladwell's “Tipping Point” concepts. The project aims to target influential HIV stakeholders in the US and internationally with a set of tailored messages in order to “tip” support for contraception as an important PMTCT strategy. To develop the messages, 25 key informant interviews were conducted from a pool of more than 500 individuals systematically identified from the international HIV/AIDS arena. Through these interviews, we explored levels of knowledge of contraception for HIV prevention, and identified common obstacles to and facilitators of implementation of the strategy.

Overall, respondents acknowledged the benefit of linking family planning (FP) and HIV programs, but identified major challenges to this becoming a reality, including separate funding streams that result in implementation of parallel programs. Other themes included political and cultural resistance to family planning, a lack of understanding about contraception for HIV prevention, insufficient published research on the effectiveness of linked FP/HIV services, a need for stronger policy support, and a need for provider training on meeting the contraceptive needs of HIV-infected women. These findings will inform a tailored advocacy intervention reaching the most influential HIV stakeholders.