title: The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. dcooper@uwc.ac.za.|School of Public Health, University of Western Cape, Private Bag X17, Bellville, 7535, South Africa. dcooper@uwc.ac.za.
authors: Diane
authors: D
authors: Cooper
authors: HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA. jem57@columbia.edu.
authors: Joanne E
authors: JE
authors: Mantell
authors: Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. jennifer.moodley@uct.ac.za.|Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. jennifer.moodley@uct.ac.za.
authors: Jennifer
authors: J
authors: Moodley
authors: Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. sumaya.mall@gmail.com.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. sumaya.mall@gmail.com.
authors: Sumaya
authors: S
authors: Mall
mesh_terms: D000328:Adult; D003267:Contraception; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D011050:Policy Making; D036301:Qualitative Research; D060728:Reproductive Health; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology