In July 1989, family planning services were integrated into 13 drug treatment programs in Philadelphia. To obtain information on the family planning needs of women in drug treatment programs, baseline interviews were conducted with 599 women. Three-quarters of these women had had a sexually transmitted disease, and although they were in a drug treatment program, 41 percent had injected drugs in the previous month. In addition, 62 percent of the women who were sexually active in the previous month had not used a contraceptive. Twelve months into the program, seven focus groups were conducted with 65 women and men to learn more about their opinions and attitudes related to contraceptives and family planning services in general. The discussions revealed that many of the participants were unsure what family planning services included, saw no need for such services or had had prior negative experiences with health care providers. There was also a great deal of misinformation about contraceptives and the effects they have on health.

The study reported here was undertaken to investigate the experiences of HIV-positive mothers with the system of services designed to help them, how they cope with the infection, particularly as it relates to parenting, and their concerns, preferences and plans for the future care of their children. A focus group method was selected because it is well suited for this type of exploratory research. A total of 40 HIV-positive mothers participated in six different focus groups. The issues that emerged from the data analysis revealed that, using systems theory, they could be logically classified by the type or level of system in which the issue was primarily located. The three system levels were (1) individual and family, (2) organizations and providers, (3) policy and community. Within each of these categories, issues could be further delineated by whether they provided women with resources or presented them with additional stress. Conclusions and recommendations for providers are made based on the systems framework that gave structure to the results.

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