The number of HIV patients receiving HIV care is growing worldwide. Due to the availability of effective treatments, we are now facing an AIDS-free generation of HIV-infected men and women. As stated by the WHO, these patients’ rights to maintain their sexual health must be respected, protected and fulfilled . These rights include the right to achieve ‘the highest attainable standard of sexual health, including access to sexual and reproductive health care services’, the right to ‘seek, receive and impart information related to sexuality’ and the right to ‘pursue a satisfying, safe and pleasurable sexual life’. HIV-infected persons are considered to have unmet needs with respect to sexual health care, i.e. counselling about safe sex, relationships, reproductive health and pregnancy, and testing and treatment for sexually transmitted infections (STIs) [2–6]. The current care systems fail to effectively address the sexual health of HIV patients, primarily because of the highly fragmented organisation of these care systems . Historically, most countries in Europe have organised HIV care and sexual health care into separate systems (i.e., hospital and public health systems). HIV care is largely hospital based and focused on HIV treatment, and there is growing awareness of the need for improved sexual health care in HIV care settings. An example is the adoption of routine STI testing guidelines in the HIV care setting in the US, the UK and the Netherlands. However, compliance with guidelines in the HIV care setting is inadequate [8–11]. In some cases, specific recommendations regarding testing at multiple anatomic sites or repeated testing are lacking. These testing approaches are essential STI control strategies that are often included in standard operating procedures at public health STI clinics . STIs, including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), increase the risk of HIV transmission [13–16]. It is important to note that sexual health care is not restricted to the provision of STI testing. Sexual health care also entails extensive counselling, partner notification, and treatment, services that are a part of the regular care offered at public health sexual health care centres .
Brickley et al. reviewed 10 intervention studies with a pre-post or multi-arm design that examined the addition of sexual health care to existing HIV services [17–26]. These studies as well as a recent study on the addition of nurse-led self-screening for STIs . have demonstrated positive effects on condom use, contraceptive use, STI screening, and quality of services. Only three of these studies evaluated a comprehensive sexual health care package that addressed both women and men [24–26]. None of these studies examined the pre-test needs of patients, a key factor in the successful integration of services. Important gaps remain in the research regarding the best approaches for addressing the needs and choices of HIV patients . Church and Lewin  proposed that policy development and provider training, while important, will not necessarily lead to the practical integration of care. They state that for optimal integration, care must shift from task orientation and functional separation to patient-centred approaches. This shift requires organisational and cultural change focusing on the patient’s perspective. Therefore, to improve the patient orientation of services, scientific research should be integrated into the care-focused clinical setting by collecting and using epidemiological and qualitative findings to optimise practice.
This study aimed to close the gap in sexual health care by implementing and evaluating a policy change regarding the combination of public health care and hospital care in an innovative, integrated STI /HIV care structure serving male and female HIV patients in the Netherlands. Using a health impact assessment framework , the potential health effects of this intervention were evaluated based on the patient’s perspective. Practical recommendations are provided for stakeholders, such as providers of care to HIV patients in the public and hospital care sectors.