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The lion at their door: threats to the reproductive rights of women living with HIV

Ximena Andion, Jaime Gher and Elisa Slattery of the Center for Reproductive Rights present an overview of the challenges to reproductive and sexual rights facing HIV-positive women across the globe, and look at what governments need to do to protect those rights.
Ximena Andion Elisa Slattery Jaime Todd-Gher
10 March 2009

A cruel paradox has been emerging during a number of Commission on the Status of Women (CSW) panels: while women bear the lion's share of care giving responsibilities within the HIV/AIDS pandemic, they are often unable to protect their own sexual and reproductive health and rights. Discriminatory and violent practices in health care facilities combined with dangerous legislative trends, are leading to gross violations of the reproductive rights of women living with HIV. (See also: Sylvia Rowley's earlier blog on Uganda's harmful new HIV law and Kimberly Whipkey's blog on the coercive sterilization of HIV-positive women.)

HIV-positive women face myriad forms of discrimination and violence in health care settings, such as coercive sterilization and delays in and denial of reproductive health care services. At a March 4 panel hosted by the Center for Reproductive Rights, Ending Abuse and Neglect: Accountability Strategies to Protect the Rights of Women living with HIV/AIDS, various organizations shared the strategies and challenges faced to ensure the protection of the reproductive rights of women living with HIV. Esther Sheenama of AWOMI recounted being sterilized in Namibia at age seventeen without her knowledge and consent because of her HIV status. She bore witness to the stigma attached to women with HIV, the presumption that contraction of HIV terminates one's sexuality, and the anguish associated with a doctor unilaterally terminating her reproductive capacity. Vasili Deliyanis of Vivo Positivo described legal efforts to stop the widespread practice of coercive sterilization of HIV-positive women in Chile, including bringing a groundbreaking case with the Center for Reproductive Rights to the Inter-American Commission on Human Rights. Maria de Bruyn of Ipas reminded attendees of the devastating example of a woman in Kolkata, India, who was forced to terminate her own pregnancy because health care staff refused to touch her due to her HIV status. The panel also provided the opportunity to launch a joint report by FIDA Kenya and the Center for Reproductive Rights - At Risk: Violations of the Rights of HIV-Positive Women in Kenya - which documents the coerced HIV testing, violations of confidentiality, and verbal abuse and neglect encountered by HIV-positive women seeking reproductive health services.

Exacerbating human rights violations faced by women in health care settings are disturbing legislative trends of criminalizing HIV exposure and transmission. Such criminalization further compromises women's rights and impacts on women's ability to care for themselves and others - without taking into account women's realities and vulnerabilities, including their vulnerability to violence, abuse and further stigmatization. These laws, often overly broad and poorly drafted, could penalize individuals who practice safer sex and/or disclose their HIV status to their sexual partners, or mothers who transmit HIV to their children, either in utero or during labour and delivery. Pregnant women may face the most severe consequences of these laws, especially considering simultaneous trends of routine and mandatory HIV testing of pregnant women. One attendee at the panel described the terrible dilemma of pregnant women in some African countries who face mandatory testing when they seek pre-natal care and the risk of often lethal violence from their partners when their status is disclosed. It is, she said, as if there is a "lion at their door".

In recognition of the many threats to the reproductive rights of women living with HIV, the oral submission by the Center for Reproductive Rights and the ATHENA Network asks the CSW to call upon governments in its 2009 outcome document to protect the sexual and reproductive health and rights of women living with HIV by:

1) Ensuring that the protection of women's rights, especially the rights to autonomy, sexual and reproductive choice, equality and non-discrimination, are at the center of the response to HIV and AIDS - so as to guarantee that women's risks and vulnerabilities are not perpetuated, but rather addressed and minimized.

2) Taking pro-active steps to reduce discrimination against HIV-positive women in health care settings, with a particular emphasis on stopping non-consensual HIV testing and disclosure of HIV status, reducing stigma that leads to denial of necessary reproductive health services, and eradicating the reprehensible practice of coercive sterilization of HIV-positive women.

3) Passing legislation and policies that require medical providers to obtain informed consent prior to HIV testing and disclosure of HIV status, impose strict confidentiality standards in the context of HIV, and create effective enforcement mechanisms to guarantee these protections.

4) Ensuring that HIV legislation and policies focus on protecting the human rights of those living with HIV and the development of comprehensive and evidence-based prevention methods, rather than introducing provisions such as criminalization of transmission which increase women's risks and vulnerabilities.

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