EUROSUPPORT V
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EUROSUPPORT V “Improving sexual and reproductive health of PLWH”. Institute of Tropical Medicine, Antwerp Department of Clinical Sciences in cooperation with SENSOA Kick-off meeting, May 6-7, 2005. Supported by the European Commission, grant agreement pending. May 6 , 2005.

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Supported by the european commission grant agreement pending

EUROSUPPORT V

“Improving sexual and reproductive health of PLWH”

Institute of Tropical Medicine, Antwerp

Department of Clinical Sciences

in cooperation with SENSOA

Kick-off meeting, May 6-7, 2005

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meting

EUROSUPPORT – General Overview

The general EUROSUPPORT philosophy:

To evaluate the support needs of people living with HIV (PLWH) and to detect shortcomings in the actual service provision through cross-sectional research carried out by a network of HIV treatment centres with the overall goal to improve care and support for PLWH.

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

EUROSUPPORT – General Overview

EUROSUPPORT I (1996-1998): Access to health care, euthanasia, HIV-testing, financial aspects 

EUROSUPPORT II (1998-2000): Effects of HAART and adherence

EUROSUPPORT III (2000-2002): Adherence and sexual dysfunctions. How to integrate safer sex counselling into standard HIV care?

EUROSUPPORT IV (2003-2004): Psychosocial needs of families affected by HIV; impact on children and family functioning

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

EUROSUPPORT V

“Improving sexual and reproductive health of PLWH”

  • Objectives of the meeting

  • ES V Study group: Teambuilding

  • Consensus building: Research agenda/research protocol

  • Organizational issues

  • Brainstorming: Qualitative research

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Background and Rationale

  • Prevention and care traditonally not well integrated areas

  • Persons living with HIV (PLWH) have been an understudied population with respect to HIV prevention and sexual risk reduction

  • Health care providers have a unique opportunity to adress these issues in the clinical context

  • ES V network: setting to investigate issues relating to the improvement of SRH-needs of PLWH

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Background and Rationale

Key-concept “sexual and reproductive health”:

Comprehensive definition of optimal sexual and reproductive health as specified in the guidingprinciples of the Cairo Conference Programme of Action, 1994:

“Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Problem statement 1: Sexual health

  • Number of new HIV infections increased by 23% in 2002 (Hamers & Downs 2004)

  • Increase in specific STIs/”outbreaks” documented

  • Net-effects of opposing forces: effective ARV-treatments vs. risk behaviour ? (Katz et al. 2000)

  • Considerable debate about the role of “HIV-optimism” (Pickett et al. 2003)

  • Evidence for sexual risk behaviour (Fisher et al. 2005)

  • Existence of false cognitions and myths relating to HIV transmission (Kippax 2003)

  • Side-effects of ARVs and emotional distress may also influence sexual behaviour (“sexual problems”) (Florence 2004; Schrooten, Colebunders et al. 2003)

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Problem statement 2: Reproductive health

  • Effective ARV treatment resulted in increase in desire to have children (Sherr et a. 2004)

  • Women living with HIV (and couples!) may want to plan pregnancy, limit their family, or avoid pregnancy…

  • Contraception: Interaction with ARVs  implications for counselling (Mitchell & Stephens 2004)

  • ES IV results: 38% did not know about their HIV-infecton when getting pregnant, 35% had planned pregnancy, 27% got pregnant unintendedly; 22% had a termination.

  • French SEROCO study (1997): 20% no contraception, 24% unplanned pregnancies, one third terminated by abortion (De Vincenzi 1997).

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

General Objectives

  • To promote the SRH of PLWH and to prevent further transmission of HIV by addressing health determinants that contribute to adopting healthy sexual lifestyles:

    • To improve current strategies of secondary prevention practices targeting PLWH (i.e. supporting PLWH in adopting safer sex practices);

    • To empower PLWH to take informed choices about fertility-related issues (such as family planning and pregnancy-related issues).

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Specific Objectives

  • Identifying SRH needs of men and women living with HIV.  

  • Identifying, analysing and disseminating models of good practice across Europe that effectively address SRH needs of PLWH.

  • Developing policy recommendations and to disseminate them among the Member States.

  • Setting up a network of experts in the area of SRH and HIV/Aids in selected Member States of the European Union.

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Translation into research questions

  • Taking a comprehensive definition of SRH into acount, what are specfic support needs of PLWH (e.g. contraceptive needs, sexual risk reduction, avoiding relapse behaviour, maintaining safer sex behaviour….)

  • What are predictors of sexual high risk behaviours among PLWH?

  • How can optimal strategies for services and counselling for sexual risk reduction in HIV-care settings be defined ?

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Theoretical framework (1)

  • Social science theories conceptualize determinants of SRH behaviours; social science theories are an important basis for promoting SRH and for designing interventions.

  • Some theories have been developed for general health behaviours (e.g. smoking), others have been developed and applied within the area of SRH:

  • Theory of Reasoned Action (Ajzen & Fishbein 1980)

  • Theory of Planned Behaviour (Ajzen & Madden 1986)

  • Aids Risk Reduction Model (Catania & Coates 1990)

  • Social Network Theory Approach (Kelly et al. 1992)

  • Information-Motivation-Behavioral Skills Model (Fisher & Fisher 1992)

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

HIV Prevention

Information

HIV Prevention

Behavioral skills

HIV Prevention

Behavior

HIV Prevention

Motivation

May 6, 2005

ES V kick-off meeting

Theoretical framework (2)

Figure 1: Overview IMB model (J. Fisher & W. Fisher, 1992, 2000; W. Fisher & J. Fisher, 1993)

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

Elicitation (1)

Assessment of factors theorized to influence risk and preventive behaviour (focus groups)

Compiling evidence (2)

Assessment of selected and prioritized factors influencing risk and preventive behaviour (self reported questionnaire)

Assessing MOGP (3)

Developing criteria and collecting best practices in the field of SRH and HIV

May 6, 2005

ES V kick-off meeting

Methodology (1)

Figure 2: Involving three steps of data assessment

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Methodology (2)

  • Elicitation research (data assessment phase 1):

  • Qualitative research

  • Using focus groups

  • Different target groups (heterosexual men, homosexual men,

  • women, minority groups, (ex-)drug-using populations;

  • Health care providers…

  • Topics to be addressed when elicitating determinants for sexual

  • risk reduction behavior and fertility related issues can be framed

  • along the three components of the IMB model

  • Compiling focus group discussion guidelines (=tool)

  • Translation

  • Hypotheses-generating…

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Methodology (3)

  • Compiling evidence (data assessment phase 2):

  • Quantitative research (survey)

  • Using an anonymous, self-reported questionnaire

  • based on the qualitative data collection

  • Main areas: sexual risk reduction behaviour; fertility incl.

  • contraceptive behaviour

  • Piloting and translation

  • Procedures: Ethical approvals and informed consent

  • Data entry and analysis by the coordinating centre

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Methodology (4)

  • Collecting models of good practice

  • (data assessment phase 3):

  • Developing needs-based criteria

  • Collecting MOGP across Europe by means of a short survey

  • Translation of the survey form

  • Identifying field organizations

  • Data entry and analysis by the main associated partner

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

May 6, 2005

ES V kick-off meeting

Data analysis

  • Qualitative data:

  • Transcripts of FG session  translation  subsequent

  • analytic induction and comparative analysis

  • Quantitative data:

  • Descriptive analysis of SRH needs

  • Bivariate analysis of demographic, psychosocial, and

  • HIV-related factors with specific outcomes (e.g. sexual risk behaviour, unintended pregnancies, desire to have children…)

  • - Multivariate analysis (logistic regression) to predict selected outcome variables

Supported by the European Commission, grant agreement pending


Supported by the european commission grant agreement pending

ES V kick-off meeting

May 6, 2005

ES V - Partners

Supported by the European Commission, grant agreement pending


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