Man/Hombre/Homme: meeting male reproductive health care needs in Colombia
Presented by Dr Alvaro Guittérez Martinez, PROFAMILIA male clinic, Colombia
Profamilia, a non-profit NGO, is one of the largest family planning organizations in the world. Founded in 1965, it currently has 48 clinics throughout Colombia. Like many family planning programmes, PROFAMILIA has focused its efforts almost exclusively on women’s reproductive health for obvious reasons. Indeed, until the 1980s, almost no attention was paid to defining, let alone meeting, male reproductive health needs - lack of information continues to be an obstacle. For example, little is known about how men view their reproductive function and their sexual lives, or about what moves men to be concerned about an unwanted pregnancy. Beginning with the opening of its first vasectomy clinic in 1985, PROFAMILIA has been reaching out to men with services to meet their reproductive health needs. They are based on a broad definition of male reproductive health that goes beyond a recognition of men’s right to control their bodies, and their need to remain free from disease, to one that includes the notion of partnership between men and women in terms of sexuality, avoiding the transmission of disease, and contraception. PROFAMILIA’s male clinics are an example of how services for men have been created as an adjunct to a long-standing and very successful programme focused mainly on women.
In ten years, the first male clinic, which offered only vasectomy services (with a low volume of patients and lack of revenue) has become one of eight diversified, comprehensive and nearly self-supporting centres for prevention, diagnosis, treatment, information and training in male reproductive health. The largest male clinic, located in Bogota, offers consultations in urology, fertility, sexology, general and plastic surgery and general medicine, and provides STD/HIV prevention services. The typical client is between 18 and 45 years of age, married, with three children and from a lower middle economic class; he is employed and has completed eight years of schooling.
One of the first major obstacles faced by the newly formed male clinic was a low volume of clients. A radio (and later, a television) campaign to inform men about the clinic’s existence was launched. The low volume of clients also indicated that male interest and/or sense of urgency about getting a vasectomy was low, whereas they were highly motivated with respect to effective and satisfying sexual functioning, and the treatment of STD. For these and other reasons, the clinics diversified as described above, and the client load increased significantly as a result.
Special attention was also given to making the facilities more attractive, welcoming and convenient. Anecdotal evidence had indicated that first impressions, and the physical appearance of facilities and the privacy they allow were very important to men, who are generally more reluctant to openly seek information or services, and are more uncomfortable than women in clinic settings. The extension of clinic hours to Saturday was extremely well received by clients.
Another lesson learned as the clinic evolved was that the men attending requested a high number of physical examinations, many of which were unnecessary. The reason, it was discovered, was that the men felt unable to discuss specific problems during the interview and their real concerns (such as problems with erections or suspicion of syphilis) emerged only during the course of the examination. The clinic then began training nurses to interview each client and assess where to send him (e.g. the laboratory, the urologist). Although only male interviewers were trained at first, the clinic now uses both men and women, since it has been found that men are just as willing to talk to women provided that they are made to feel at ease and their privacy is respected.
As part of these efforts to provide better sexual and reproductive health services to men, PROFAMILIA, with some support from IPPF, launched an HIV/AIDS prevention programme which emphasizes information dissemination. The clinics have begun to sell condoms at a very low price and in 1994 alone sold over 8 million. HIV testing and counselling were once available in clinics, but now only AIDS education is provided and patients are referred to teaching hospitals for testing services and for secondary and tertiary treatment of AIDS-related illnesses.
The success of the male clinics is reflected in their growth. Once dependent on international agencies for start-up and operational funding, the Bogota clinic’s programme diversification strategy has brought it to 92% self-sufficiency through cost recovery, with fees remaining low and affordable (Figure 11). It serves an average of 750 new clients each month and provides 500 follow-up visits. It has become a resource and training centre for other countries in the region which are developing male-focused health clinics.
Growth in the sustainability of a male reproductive health clinic in Colombia*
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