Supported by the European Commission, grant agreement pending

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. ES V kick-off meeting May 6, 2005 ES V - Partners Supported by the European Commission, grant agreement pending