Cooper Diane, Mantell Joanne E, Moodley Jennifer, Mall Sumaya
Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
School of Public Health, University of Western Cape, Private Bag X17, Bellville, 7535, South Africa.
BMC Public Health. 2015 Mar 4;15:217. doi: 10.1186/s12889-015-1577-9.
Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa's prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH's SRH and combatting the global HIV epidemic. This paper explores South African policymakers' perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation.
It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008-2009 and 2011-2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH's childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes.
Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier.
The past decade's HIV policy changes have increased opportunities for SRH-HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.
在全球范围内，尤其是在撒哈拉以南非洲地区（该地区艾滋病毒感染率最高），由同一机构提供性与生殖健康（SRH）及艾滋病毒防治政策和服务的整合工作被列为优先事项。南非拥有全球最大的抗逆转录病毒治疗（ART）项目，估计有270万人接受抗逆转录病毒治疗，这提升了南非作为全球艾滋病毒治疗领导者的地位。2011年，南部非洲艾滋病毒临床医生协会发布了针对艾滋病毒感染者（PLWH）的安全受孕指南；2013年，南非政府发布了避孕指南，强调了性与生殖健康及艾滋病毒感染者生育规划服务的重要性。解决意外怀孕、安全受孕和孕产妇健康问题对于改善艾滋病毒感染者的性与生殖健康以及抗击全球艾滋病毒流行至关重要。本文探讨了南非政策制定者对公共部门性与生殖健康 - 艾滋病毒政策整合的看法，特别关注针对艾滋病毒感染者的安全受孕国家和地区政策以及避孕指南实施的必要性。
本文借鉴了2008 - 2009年以及2011 - 2012年期间对国家、省级和民间社会政策制定者进行的42次深入访谈，当时接受抗逆转录病毒治疗的人数不断增加。访谈集中在三个关键领域：对艾滋病毒感染者生育问题的看法；性与生殖健康 - 艾滋病毒整合政策和服务的现状；以及在南非初级保健服务重组中对性与生殖健康 - 艾滋病毒整合的想法和建议。数据根据主题进行编码和分析。
参与者支持性与生殖健康 - 艾滋病毒综合政策和服务。然而，所确定的整合挑战包括缺乏政策和指南、提供者培训不足、垂直规划、提供者工作负担过重以及卫生系统薄弱。参与者承认，性与生殖健康 - 艾滋病毒整合政策，特别是关于安全受孕、避孕和宫颈癌的政策，一直被忽视。政策制定者支持公共部门采用安全受孕政策和服务。在扩大抗逆转录病毒治疗后接受访谈的参与者比早期接受访谈的参与者对艾滋病毒感染者的安全受孕政策更为积极。
过去十年的艾滋病毒政策变化增加了性与生殖健康 - 艾滋病毒整合的机会。这些研究结果为国际、区域和国家性与生殖健康 - 艾滋病毒政策及服务整合举措提供了重要见解。
