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Integration and disintegration in caring for HIV-positive women

In the wake of a new UK Health and Social Care Bill that has disintegrated HIV service provision from sexual and reproductive health (SRH), joined-up thinking around sexual health is more important than ever. A cluster of international papers on HIV in this journal issue makes this crystal clear, by highlighting how HIV affects unplanned pregnancy and how contraceptive choices affect HIV transmission. HIV-positive women not planning a pregnancy badly need effective contraception, yet face potential drug interactions between HIV medication and hormonal contraception, plus, as a South African study highlights, higher risks of HIV transmission with long-acting reversible contraception (LARC). Worse still, they may also face clinicians who do not even discuss contraception with them at all, as an Australian study shows. Some struggle to understand the legal implications of HIV infection, and need better support from clinicians. Meanwhile in resource-poor settings in sub-Saharan Africa where, in contrast to the UK, attempts are currently being made to integrate services, data on contraceptive counselling are often missing.

Together, these papers leave no one working in sexual health with any excuse for complacency or tunnel vision. Showing the dangers of an overly narrow focus on individual HIV or contraception outcomes, however individually important, these articles remind us all to look beyond the boundaries of our own immediate roles and settings, to consider the sexual health of whole individuals. As this journal issue goes to press, World AIDS day celebrates plummeting rates of progression to AIDS and vertical transmission, and rising numbers of non-infectious individuals. HIV is no longer a death sentence. But it remains a serious chronic disease, requiring integrated care, including contraception.

Sandy Goldbeck-Wood


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