Davies, N.E., Matthews, L.T., Crankshaw, T.L., et al. Journal of the International AIDS Society (March 2017), 20(Suppl 1): 36–42, doi:10.7448/IAS.20.2.21271.
The authors of this commentary used examples from South Africa to identify key obstacles to implementation of policies to help serodiscordant couples meet their reproductive goals and discussed ways of improving implementation of such policies. They identified four key barriers to policy implementation: poor translation of policies into implementation strategies; entrenched negative attitudes about people living with HIV (PLHIV) among organizations and providers; insufficient training, including training on safe conception; and insufficient engagement and education of communities on HIV and opportunities for receiving treatment and safely making reproductive choices. Two challenges—the high rate of unintended pregnancies and low awareness of HIV status in the general population—also limit uptake of options for safer conception. The authors recommended the following approaches for addressing these barriers: incorporating safe conception programs (along with routine monitoring) into existing programs for test and treat and eliminating mother-to-child transmission; a stepped care approach to training for primary health care nurses; and extensive activities to engage communities in actions to address HIV. These steps, the authors said, could be used to inform policy development and implementation in South Africa and other HIV high-burden countries.