Experiences, barriers, and enablers of integrated HIV and sexual and reproductive health services in Nigeria: a qualitative study of service users and healthcare providers

BACKGROUND: Integrating HIV and sexual and reproductive health (SRH) services is a global priority for improving access to comprehensive, equitable, and people-centred care. However, people living with HIV (PLHIV) continue to experience unmet SRH needs, and evidence on how integrated services are experienced, delivered, and utilised in routine care settings remains limited in Nigeria. This study explored service users' and healthcare providers' experiences of integrated HIV-SRH services, including patterns of service delivery and utilisation, barriers, facilitators, and recommendations for strengthening integration.

METHODS: This qualitative study was conducted in 2025 in Lagos and Oyo States, South-West Nigeria. In-depth interviews were conducted with HIV service users and healthcare providers involved in delivering or accessing integrated HIV-SRH services. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. A hybrid inductive-deductive coding approach was applied, supported by Quirkos software.

RESULTS: Participants described strong and sustained engagement with HIV services but more selective and fragmented use of SRH services. While healthcare providers articulated a clear understanding of HIV-SRH integration as a holistic and client-centred model of care, many service users had limited awareness of integration as a formal care approach. Integrated service delivery was enabled by supportive and non-judgmental staff attitudes, effective follow-up systems, client-centred relationships, and social and family support. However, multiple intersecting barriers constrained effective integration, including chronic staffing shortages and long waiting times, inconsistent availability of essential resources, inadequate infrastructure, stigma and discrimination, sociocultural norms, limited provider training, and reliance on donor funding. Despite these challenges, user satisfaction with HIV services remained high, largely driven by positive provider-client interactions. Participants recommended strengthening integration through sustained free access to medications, workforce expansion and capacity building, improved service coordination, community engagement, and increased domestic resource mobilisation.

CONCLUSION: Integrated HIV and SRH services are widely valued by both service users and healthcare providers in South-West Nigeria and contribute to patient-centred care and stigma reduction. However, gaps in user awareness, health system constraints, and persistent social barriers limit the full potential of integration. Addressing these challenges through targeted health system strengthening, sustained community engagement, and equitable financing is essential for improving access, quality, and sustainability of integrated HIV-SRH services.