Injection drug use in Rural Iran: integrating HIV prevention into iran's rural primary health care system.

Major opium trafficking routes traverse rural Iran, but patterns of drug use and HIV infection in these areas are unknown. In 2004, Iran's Ministry of Health integrated substance use treatment and HIV prevention into the rural primary health care system. Active opium or heroin users (N = 478) were enrolled in a rural clinic. Participants received counseling for abstinence from substances, or daily needle exchange and condoms. On enrollment, 108 (23%) reported injecting; of these, 79 (73%) reported sharing needles. Of 65 participants tested for HIV, 46 (72%) tested positive. Participants who received daily needle exchange/condoms stayed in the program longer than those who did not (AOR 2.08, 95% CI 1.1-3.88). This project demonstrates that HIV risks exist in rural Iran and suggests the innovative use of Iran's rural health care system to extend prevention and treatment services to these populations.

Airing method-specific advertisements.

PIP: The Turkish Family Health and Planning Foundation initiated the commercial marketing of contraceptives in 1989 as part of a Contraceptive Social Marketing (CSM) program to make available low-cost contraceptives. In 1988 modern methods were used by 31% and traditional methods by 32.3%, while 36.6% used no contraceptives. Only 6.2% were current pill users mainly because of health reasons since high-dose pills dominated the market. A 1990 survey among urban consumers indicated a 94% awareness of contraceptive methods, 76.1% of current use, and preference for the IUD. The side effects of the pill were cited for disliking it, and the condom was rated higher. The CSM project aims at popularizing low-dose pills by explaining the differences and benefits regarding high-dose pills. It collaborated with manufacturers: Schering, Wyeth, Organon, and Eczacibasi Ilac. In 1991 a TV and radio advertisement campaign started that involves the low-dose products Microgynon, Triquilar, Desolet, Lo-Ovral, and Tri-Nordial. The introduction of the Okey condom by Eczacibasi Ilac. In June 1991 also entailed extensive promotion with newspaper ads and TV spots after getting official permission. 1.3 million condoms were sold in the 1st 2 months in 13,000 retail outlets, and 4 million more were projected to be sold. A shift of the attitude of supermarket owners allowing stocking of condoms and the support of the Turkish Ministry of Health, USAID, and the Turkish Radio and Television Bureau has facilitated the CSM project implementation that will profoundly affect family planning in Turkey.^ieng

Contraceptive social marketing in the Philippines. A new initiative.

PIP: By offering contraceptives at subsidized prices through pharmacies, drugstores, grocery shops, and other conveniently-located retail outlets, and promoting them with modern marketing techniques, social marketing programs can do much to reduce the unmet need for family planning. Users obviously benefit, while the family planning program benefits from advertising and marketing skills and some cost recovery. The Philippine Contraceptive Social Marketing Project (PCSMP) was formally launched in the Philippines in 1993 in response to the large unmet need in the country, and initial results are promising. The project was started with funding from the US Agency for International Development to provide affordable, quality contraceptives through the private sector to Filipino couples who choose to practice family planning. A 1988 survey found that only 22.4% of women aged 15-44 years were using modern methods of contraception and 13.8% were using traditional methods; approximately three million women therefore had unmet need for family planning. The PCSMP established an AIDS prevention component and a birth spacing component, enlisting the participation of oral contraceptive manufacturers Wyeth, Organon, and Schering, along with one condom distributor, Philusa. These companies lowered their product prices by 20% for the program. Despite objections from the Catholic church, sales of both oral pills and condoms increased in the first year. In its second year, the program will advertise Sensation condoms and the Couple's Choice Pills via television, through intensive distribution drives, consumer and trade promotions, and the continuous training of health professionals. The contraceptive injectable DMPA will be added to the Couple's Choice product line in April 1994. This method, too, will be heavily promoted.^ieng