Sexual and reproductive health and rights and mHealth in policy and practice in South Africa.

Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights. We argue that in terms of policy, there is little overlap between health rights and communication technology. In the area of practice, however, significant interventions address aspects of reproductive health. At present, the extent to which mHealth addresses the full range of reproductive justice and sexual and reproductive health and rights is limited, particularly in terms of government initiatives. The paper argues that mHealth projects tend to avoid contentious aspects of sexual health, while addressing favourable topics such as pregnancy and motherhood. The ways in which information is framed in mHealth mirrors current gaps within sexual and reproductive health and rights, where a limited and conservative lens predominates, and which may result in narrow programming and implementation of services.

Safe abortion in South Africa: "We have wonderful laws but we don't have people to implement those laws".

In South Africa, abortion was legalized in 1996, during the nation's transition from apartheid to independence and democracy, under the Choice on Termination of Pregnancy Act (CTOPA). The law drew from both a public health and rights-based framework. A coalition of advocates played a key role in passage. In the years after the CTOPA was passed, abortion services were expanded-in part through a 2008 amendment that allowed trained registered nurses to provide abortions-and deaths from unsafe abortions decreased. However, there have been hurdles to implementation, including competing health priorities such as HIV/AIDS, and a high number of conscientious objectors. There is a geographic disparity in accessibility of abortion services between provinces as well as between urban and rural areas. Women seeking legal abortions face a lack of accessible information on where to obtain an abortion, often experience stigma at facilities, and many obtain illegal procedures.

From HIV prevention to reproductive health choices: HIV/AIDS treatment guidelines for women of reproductive age.

In South Africa, the private sector has responded to the HIV epidemic by providing treatment in the form of highly active antiretroviral therapy (HAART). The private sector has paved the way for policy and treatment regimens, while the public sector has reviewed health-systems capacity and the political will to provide treatment. The paradigm of prevention of mother-to-child transmission of HIV (PMTCT) has led the way as a clear evidenced-based method of treatment and prevention in South Africa. In sub-Saharan Africa, the HIV epidemic is feminised as a growing proportion of infections occurs among women or affects women. While access to HIV treatment has been contested in South Africa, women's sexual and reproductive health has been neglected. This paper is a reflection and critical review of current practice. Many HIV-positive women desire to choose to have a child, while the best choice of contraception for women on HAART is not well understood. In some areas there are reports of women being forced to accept injectable contraceptives. Some women who learn of their HIV-positive status during pregnancy may want to choose to terminate their pregnancy. There is a clear absence of HIV/AIDS-treatment guidelines for women of reproductive age, including options for HAART and options regarding fertility intentions. A range of other sexual and reproductive health areas (relevant to both the public and private health sectors) are neglected; these include depression and anxiety, violence against women, HIV-testing practices, screening for cervical cancer, and vaccination. Given the narrow focus of HAART, it is important to expand HIV treatment conceptually, by applying a broader view of the needs of working women (and men), and so contribute to better HIV prevention and treatment practices. There is a need to move from an HIV/AIDS-care maternal-health paradigm to one that embraces women's sexual and reproductive health and rights.

Needlestick injuries in an era of HIV: technical and personal aspects.

Hospitals are workplaces in which HIV has double significance. Needlestick accidents link patients, healthcare workers and cleaning staff through the risk of occupational exposure to HIV. Additionally, concern over needlestick injuries may embody HIV stigma, discrimination and fear. This paper draws on qualitative research from a one-year case study at a large, private South African healthcare company that runs a number of hospitals across the country. Issues surrounding needlestick injuries were discussed with hospital managers, union members, infection-control nurses, health and safety representatives, HIV/AIDS counsellors, and general nursing staff. Needlestick injuries presented a complex set of technical and personal concerns. The research shows that cost-management, human rights, health and safety procedures, stigma and discrimination, and the quality of patient care are all relevant to needlestick injuries in an era of HIV. Participants' concerns focused on: establishing safety procedures, the cost and efficacy of waste disposal systems, access to post-exposure prophylaxis, legal implications, and baseline HIV tests following needlestick injuries. The last topic revealed numerous other issues, including the possibility of health workers 'legitimising' sexually acquired HIV infection by passing it off as an occupational accident. Healthcare facilities should ensure procedures that minimise occupational exposure to HIV and that minimise infection risk in the event of accidents. We propose that hospitals ought to directly encourage staff to learn their HIV status and seek disease management when needed. Likewise, better approaches to dealing with HIV stigma and discrimination are needed, especially to dispel myths of good and bad ways of contracting HIV.