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In 1992 the US Agency for International Development provided funding to integrate HIV/sexually transmitted disease (STD) prevention to the programs and services of three family planning associations in Latin America and the Caribbean: BEMFAM/Brazil ASHONPLAFA/Honduras and FAMPLAN/Jamaica. This step required a transition to a more client-centered sexually implicit approach to counseling. In each case program development was guided by a needs assessment. Staff training covered basic information on HIV/STDs gender issues counseling skills values clarification and developing comfort with sexual language. Before the program staff tended to promote condoms as a back-up method or a last choice when other methods were not available. 3 years after program implementation staff are highlighting the dual benefits of condom use for pregnancy and HIV/STD prevention and condom use has increased significantly. Although each of the programs has its own characteristics common lessons include the following: 1) an emphasis on the sexuality concerns of clients requires an institutional commitment from top program managers; 2) involvement of all staff in planning implementation and monitoring of the introduction of integrated programs gives staff a sense of personal ownership; 3) the inclusion of discussion of sexuality in the counseling process actually saves time through its emphasis on individual client needs; 4) individualized counseling and service delivery improve the quality of services offered and staff satisfaction; and 5) there is little difficulty getting clients to discuss their sexual lives openly even in groups.

Introducing sexuality within family planning: The experience of three HIV/STD prevention projects from Latin America and the Caribbean