Need, demand and missed opportunities for integrated reproductive health–HIV care in Kenya and Swaziland: evidence from household surveys

OBJECTIVE:Little is known about the need and demand for integrated reproductive health and HIV services at the population level. DESIGN:Descriptive data analysis of household surveys collected by the Integra Initiative. METHODS:Household surveys were conducted among 18–49-year-olds in Kenya (N = 1752) and Swaziland (N = 779) in 2009. Data on fertility intentions, contraceptive use, sexual behaviours and HIV testing were used to determine unmet needs. Demand for integrated services was defined as wanting reproductive health services with HIV/sexually transmitted infection (STI) services within one visit. RESULTS:At the population level, family planning needs (90%) were higher than HIV/STI prevention needs53% (women) and 75% (men). Fewer had unmet family planning needs through non-use of contraceptives17% (women) and 27% (men); versus unmet HIV/STI prevention needs through inconsistent condom use48 and 26% of women; 51 and 32% of men in Kenya and Swaziland, respectively. Dual need was higher for men64% (Kenya) and 73% (Swaziland) versus women (48%) with more unmet in Kenya (43%) compared to Swaziland (25%). Missed opportunities for integrated service provision were high among women49 and 57% with unmet family planning needs; and 55 and 32% with unmet HIV/STI prevention needs in Kenya and Swaziland, respectively, used services, but did not receive the needed service. Most men with unmet needs were non-service users. Approximately a quarter of women wanted and received integrated reproductive health–HIV/STI services in both countries. CONCLUSIONS:Demand creation at the community level and provider-initiated integrated service provision are needed, using different strategies for men and women, to address substantial family planning and HIV/STI prevention needs.