Supporting HIV prevention and reproductive goals in an HIV-endemic setting: taking safer conception services from policy to practice in South Africa

INTRODUCTION: Safer conception care encompasses HIV care, treatment and prevention for persons living with HIV and their partners who desire children. In 2012, South Africa endorsed a progressive safer conception policy supporting HIV-affected persons to safely meet reproductive goals. However, aside from select research-supported clinics, widespread implementation has not occurred. Using South Africa as a case study, we identify key obstacles to policy implementation and offer recommendations to catalyse expansion of these services throughout South Africa and further afield. DISCUSSION: Four key implementation barriers were identified by combining authors’ safer conception service delivery experiences with available literature. First, strategic implementation frameworks stipulating where, and by whom, safer conception services should be provided are needed. Integrating safer conception services into universal test-and-treat (UTT) and elimination-of-mother-to-child-transmission (eMTCT) priority programmes would support HIV testing, ART initiation and management, viral suppression and early antenatal/eMTCT care engagement goals, reducing horizontal and vertical transmissions. Embedding measurable safer conception targets into these priority programmes would ensure accountability for implementation progress. Second, facing an organizational clinic culture that often undermines clients’ reproductive rights, healthcare providers’ (HCP) positive experiences with eMTCT and enthusiasm for UTT provide opportunities to shift facilitylevel and individual attitudes in favour of safer conception provision. Third, safer conception guidelines have not been incorporated into HCP training. Combining safer conception with “test-and-treat” training would efficiently ensure that providers are better equipped to discuss clients’ reproductive goals and support safer conception practices. Lastly, HIVaffected couples remain largely unaware of safer conception strategies. HIV-affected populations need to be mobilized to engage with safer conception options alongside other HIV-related healthcare services. CONCLUSION: Key barriers to widespread safer conception service provision in South Africa include poor translation of policy into practical and measurable implementation plans, inadequate training and limited community engagement. South Africa should leverage the momentum and accountability associated with high priority UTT and eMTCT programmes to reinvigorate implementation efforts by incorporating safer conception into implementation and monitoring frameworks and associated HCP training and community engagement activities. South Africa’s experiences should be used to inform policy development and implementation processes in other HIV high-burden countries.IS

“I feel like death on legs”: COVID-19 isolation and mental health

This study investigates the personal and collective responses to COVID-19, as it is described in British personalstories and newspaper reports from Britain and Sri Lanka and examines the social and economic impact of thepandemic on different societies. Although some studies have been done on the impact of COVID-19, none of thesestudies have focused specifically on the impact the coronavirus has had on different societies because of the globallockdown and restrictions on people’s movements. This study attempts to address this gap in the literature byfocusing on how the language used in a corpus of personal stories and newspaper reports collected over a span ofone month, reveal the impact of COVID-19 on two societies by investigating how self-isolation and lockdown isleading to mental health breakdown in individuals and affecting wider social and economic collapse. The data wasanalysed using corpus linguistics methodology such as keyword analysis using AntConc (Anthony, 2019) andLinguistic Inquiry and Word Count (LIWC) (Pennebaker Conglomerates, 2015). Thefindings from LIWC showsthat the enforced self-isolation is leading to mental health breakdown. The analysis of the news reports show thatBritain’s priorities are centred on the economy whereas Sri Lankan newspapers focus on educating people aboutthe severity of COVID-19.1. IntroductionThe coronavirus pandemic has been likened to a war situation andmetaphors such as‘battle’,‘fight’,‘combat’,‘attack’,‘defend’,‘beat’etc.,have been used by World leaders to describe the response to thepandemic (Maxwell et al., 2020).Magnus (25th February 2020)notesone such metaphor that gained traction at the start of the pandemic:“President Xi Jinping has vowed to wage a‘people’s war’against theCOVID-19 epidemic.”The treatment of the pandemic as a war is also seenin the following headline by Britain’s Sun newspaper (Clark, March 15,2020) where the Prime Minister is said‘to declare war’and his actionplan is referred to as a‘battle plan’:“Army on standby as Boris declareswar on coronavirus with battle plan to kill the deadly virus”. These usesof war metaphors suggest the scale of the pandemic globally and theeffect that it is having on the population as a whole. On 13th March,2020, the Prime Minister of Britain stated on national TV that“We’regoing to lose many more loved ones”(Binns, 13th March, 2020). Thescale of the spread has brought the issue of mental health well-being tothe forefront. The Guidance from the UK government states“the coro-navirus (COVID19) outbreak is going to have an impact on everyone’sdaily lives, as the government and the NHS take necessary steps tomanage the outbreak, reduce transmission and treat those who needmedical attention”. The Public Health England website advices people tolook after their well-being by‘connecting with others’,‘helping andsupporting others’,‘by talking about worries’,‘looking after one’sphysical well-being’,‘trying to manage difficult feelings’,‘managingmedia and information intake’,‘sticking to a regular routine and sleeppattern’, etc (Gov, 2020). The awareness of the pressure that the lock-down is placing on people’s mental health is increasing and this is seen bythe support for the government campaign by the Duke and Duchess ofCambridge (BBC News, 29th March, 2020), who remarked:“The last fewweeks have been anxious and unsettling for everyone. We have to taketime to support each other andfind ways to look after our mental health.By pulling together and taking simple steps each day, we can all be betterprepared for the times ahead" (Table 5 and 6).As the COVID-19 pandemic has been branded as‘the worst healthcrisis in a generation’(Binns, March 13th, 2020), the problem of people’smental well-being is an important issue to address.Rim�e et al. (1991)state that during traumatic situations such as natural disasters and pan-demics, people process the trauma of the situation by coming togetherand that newspapers mirror this collective script of how the trauma isbeing processed by society. This is confirmed byGortner and Pennebaker(2003, p. 583), who noted that newspapers mirror the“psychologicaldynamics of society”. Therefore, the purpose of this paper is to investi-gate the social impact the novel coronavirus is having on two societies byexamining a selected corpus of news reports and personal stories