Cambodia: Family Planning Programs and HIV/AIDS Services

Funded by the United Stated Agency for International Development (USAID), this report describes the results of six focus group held in Cambodia in December 2004. These focus groups, planned and implemented by the POLICY Project, were designed to assess the views of family planning users, providers and HIV+ women on the "accessibility and quality of FP [Family Planning] services, particularly in light of the HIV/AIDS epidemic in Cambodia." From these discussions, the author has produced a series of conclusions and recommendations for improving the implementation of family planning and HIV prevention measures in Cambodia.



The six focus groups were made up of two groups of family planning (FP) users, two of FP providers and two of HIV+ women. Each group was lead by a Cambodian researcher trained and experienced in leading such groups. Both men and women were invited to take part in the groups, but in most groups the participants were predominantly female.



Family Planning Users


Among the members of the two Family Planning Users groups, all actively used and approved of modern family planning methods. Both groups noted that use of condoms within marriage was not popular, and expressed the need for male involvement in FP if condom use was to become more popular.



None of the participants had ever used or heard of the Voluntary Confidential Counselling and Testing (VCCT) or Prevention of Mother-to-Child Transmission (PMTCT) of HIV services. Participants, however, believed that people with HIV needed access to family planning, and members of one group stressed the need for equality in providing these services to HIV+ presons.

HIV+ Women

Women the two HIV+ focus groups were all FP users, and had knowledge of risks of passing HIV through childbirth and breast milk. All husbands who were still living were also HIV+. The women all chose not to have more children, and most used condoms for family planning. The reasons for condom usage included fears of other sexually transmitted diseases and a belief that contraceptive pills and injections might interfere with their treatments. All participants, however, knew women whose husbands refused to use condoms.



HIV+ participants generally felt that HIV/AIDS services should be integrated into health facilities, and that condoms should be better promoted for family planning. They particularly noted discrimination against HIV+ persons in the private medical sector. Of those with access to voluntary testing services, half had utilised these, and those who had used the Prevention of Mother-to-Child Transmission (PMTCT) of HIV services were very impressed.



Participants in the HIV+ focus groups felt men should be more involved in family planning, and some participants recommended the use of television and radio to help persuade men to be open with their wives about their HIV status.

Service Providers

Service providers noted that there has been an increase in demand for FP services since 2000, and that awareness of HIV/AIDS has increased. Difficulties they note include countering local misinformation, privacy concerns of users, and the importance of getting men involved in family planning decisions.



Providers observed that while condom distributions have increased, most were believed to be used for extramarital sex. They noted difficulties in convincing both men and women to adopt condoms for family planning, and found that when couples did agree to use condoms it was the woman who would pick them up from the centre.



Service providers were sceptical about integrating HIV/AIDS services into their health centres, citing clients’ fears of discrimination and lack of facilities. Providers also expressed some personal fear of contracting HIV in the workplace.

The report draws the following conclusions:

1. The demand for family planning is growing.
2. The demand for condoms as an FP method is still low compared to other methods.
3. Family planning is important because of, and not in spite of, the HIV/AIDS epidemic.
4. Dual protection is promoted by service providers but dual methods are not.
5. The involvement of men in FP and HIV/AIDS services is still minimal and should be increased.
6. Neither clients nor service providers felt that services in the public sector had been compromised over fears of HIV transmission.
7. HIV+ women were concerned about discrimination.
8. Service providers acknowledge the sensitive nature of both family planning and HIV/AIDS.
9. Minimal integration of FP and HIV/AIDS services exists
10. Awareness of HIV/AIDS is high, although misconceptions among HIV+ women, FP clients, and service providers still persist.
11. Awareness among FP clients of VCCT and PMTCT is extremely low.

In addition, the author provides the following recommendations:

• Male involvement must be encouraged to readdress the current attitudes toward condoms.
• The capacity and resources of services providers, particularly in the rural areas and in the private sector, must be developed. This is essential to readdress the current environment in which FP and HIV/AIDS services are managed and to reduce discrimination and misconceptions about
  HIV/AIDS, which prevent the adoption of adequate protection and FP methods.
• Information, education, and communication (IEC) campaigns, through multimedia, must be
  developed to reinforce all these changes and help turn the stigma felt toward those with
  HIV/AIDS into compassion and understanding.
• At the local level, there is little or no attempt to integrate HIV/AIDS and FP services. The
  resources and the knowledge to do this are severely lacking.

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