Pathfinder International are intending to scale up the use of Implanon in Ethiopia. This is a hormonal contraceptive implant, inserted under the skin. I hope some care is taken to avoid accidental transmission of blood borne infections, such as hepatitis, HIV and various bactrial conditions.
My attention has been drawn to the 2005 Demographic and Health Survey for Ethiopia, which shows that HIV prevalence is particularly high among women who received care from a health professional during delivery in the past three years, at 9.9%, compared to national prevalence of less than 1.5%. In contrast, HIV prevalence among those who gave birth without care from a health professional was only 1.2%.
There are similarly worrying contrasts for ante-natal care (ANC), with 3.5% prevalence among those who receive ANC by a health professional, compared to only 1% among those who did not.
In common with all high HIV prevalence African countries, HIV prevalence is higher among women than men. It is also many times higher in urban areas, compared to rural areas. And it is higher among the wealthy than it is among the poor.
These figures, and others in a more recent Preliminary Demographic and Health Survey for Ethiopia, suggest that HIV is very unlikely to be transmitted sexually. This raises the question of how it is being transmitted. Could wealthier, city dwelling people, with better access to health professionals face higher risks than poorer, rural dwelling people, who may never see a health professional face to face? Contraceptive use is also far higher in urban than rural areas.
Pathfinder use the popular buzzword, ‘task-shifting’, to reassure us that there may be few health professionals in the country, but some kind of training can be given to those there are, even to those who are not health professionals but are doing work that should be done by professionals. The term ‘task-shifting’ is a bit like ‘coping mechanisms’ and ‘extended families’, which allow us to believe that they’ll be ok, after all, they are Africans.
It is to be hoped that use of Implanon and other invasive family planning methods that involve breaking of the skin are carried out in sterile conditions by people who know the risks and are taking the necessary precautions to avoid them.
It would also be good to think this campaign involves informing Ethiopians about non-sexual risks of HIV transmission, such as those faced by those using certain forms of birth control, such as Implanon and other implants. Implants need to be removed in sterile conditions, as well as inserted in sterile conditions.