Abstract
Sir: We were very interested to read the article by Samuel et al. 1 on providing contraception and medical gynaecology for HIV-positive women in a one-stop clinic.
All aspects of care for HIV-positive women at the Garden Clinic improved after introducing an integrated service in the form of a one-stop clinic offering sexually transmitted infection (STI) screening, cervical cytology and family planning. 2 In this audit the one-stop approach (notes after 2005) was compared with an earlier time period (2002), showing that the provision and uptake of cervical cytology, contraception counselling, sexual history-taking and STI screening had become more widespread among the women attending our service.
There are many constraints on providing such one-stop care, particularly with regard to funding. Some genitourinary (GU) medicine clinics do not provide contraceptive services at all, while others require women to attend at separate times for STI screening and family planning. The ‘Payment by Results’ tariff system pays a fixed rate for each visit, and acts as a disincentive to providing one-stop services.
HIV-positive women require specialist contraceptive advice because of unanswered questions regarding contraceptive efficacy and dosing in those taking antiretroviral medication. Some aspects of medical gynaecology require special attention in HIV-positive women, including the management of abnormal cervical cytology. There are specific issues around preconception counselling and infertility, with the need to minimize risks of HIV transmission to uninfected partners and to the child. There is a continuing reticence among some HIV-positive women (particularly women from ethnic minorities) in disclosing their HIV-positive status to practitioners outside their specialist centre. One-stop shops for HIV-positive women can provide high quality, specialist, patient-focussed care and there should be careful collaboration with Primary Care Trusts to ensure appropriate funding.