HIV Testing and Reproductive Choice – How Did The Rights-Based Approach Play Out?

Maria de Bruyn

Any reflections on the XVI International Conference on AIDS are necessarily subjective, as each person reporting attended different sessions, had different goals and talked to different people at different times. Nevertheless, taking the various perspectives into account can give us a more comprehensive view of what transpired in Toronto.

Advocates for women’s and rights issues can rightly take pride in having focused at least some attention on topics that were relatively neglected, such as female-controlled (at least to some extent!) barrier methods (female condoms, microbicides, diaphragms and cervical caps) and violence against women.

Any reflections on the XVI International Conference on AIDS are necessarily subjective, as each person reporting attended different sessions, had different goals and talked to different people at different times. Nevertheless, taking the various perspectives into account can give us a more comprehensive view of what transpired in Toronto.

Advocates for women’s and rights issues can rightly take pride in having focused at least some attention on topics that were relatively neglected, such as female-controlled (at least to some extent!) barrier methods (female condoms, microbicides, diaphragms and cervical caps) and violence against women.

One hot topic that was debated in formal and informal sessions was the current push by national and international agencies to have as many people tested for HIV as possible. Most people agree that knowing one’s HIV status can have many benefits, not the least of which is enabling a person to seek appropriate treatment in a timely manner (assuming that affordable treatment is available within a reasonable distance from their place of residence, of course). What concerns those who question the speed with which testing initiatives are being expanded is whether this public-health measure will be based on respect for individual human rights.

Some worry that routine offers of HIV tests by health-care providers may easily turn into routine imposition of HIV tests for patients who are not knowledgeable or confident enough to ask about the benefits and risks associated with tests. (And just think about it – how often have you asked your physician all the questions you had about a medical exam, procedure or prescription? Have you never felt just a little intimidated or reluctant to challenge or question what your doctor says? I know that it’s happened to me and my well-to-do, highly educated, empowered female friends; women raised to be subordinate will have even more problems with this.)

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The growing shortage of health-care workers in many areas means that health systems don’t have adequate staffing levels to ensure that patients can give informed consent or receive counseling. Inadequate infrastructure can mean that confidentiality is not ensured as no separate spaces are available where people can receive test results in privacy. Or people’s confidentiality is breached later when they can only access antiretroviral therapy (ART) at offices labeled “AIDS Services,” “ART for adults” and “ART for children.” When women are asked to take HIV tests during labor and delivery, they will often be in a ward with others – how can protocols ensure that their consent is informed and private? And how well can they consider benefits and risks at such a time?

At two different sessions on testing and counseling, speakers highlighted the increased numbers of people tested through Botswana’s provider-initiated testing system. However, it was only in response to an audience member’s question that one scientist admitted they were only now starting to consider evaluations that might also assess client satisfaction, access to ART and possible negative impacts subsequent to testing.

The ATHENA Network and International Community of Women Living with HIV/AIDS (ICW), with assistance from the Center for Health and Gender Equity (CHANGE), organized a press conference to highlight the need to examine testing from a gender perspective. For example, the experiences of ICW members point to the fact that “Testing services often do not address the stigma, discrimination and related violence, and loss of livelihood that many women face if their status becomes known. This makes seeking treatment and care a devastating prospect for many.”

The questions raised about the push for testing were good and necessary. What we need to hear about as soon as possible, however, is how the challenges to human rights-based testing and counseling are being tackled. Just a few examples (there are more!). Many physicians are coming to Africa from other countries to help deal with the health-care worker shortage (e.g., from Cuba). How well can doctors who don’t speak local languages ensure that people are able to give informed consent for a test? A study coordinated by Ipas on meeting HIV-positive women’s health needs recommends that women living with HIV be paid as counselors, instead of having them supplement health services as volunteers. Health-care workers in Argentina confirmed that HIV-positive counselors can offer superior services – how many testing programs are taking this approach? How do testing protocols take into account follow-up of people who tested positive (e.g., in accessing ART if needed or in providing treatment and support for mothers and children)?

Regarding reproductive choice: in 1992, when ICW was founded, the network published 12 statements on what was needed to improve the situation of women living with HIV/AIDS; one of those statements was: “The right to be respected and supported in our choices about reproduction, including the right to have, or not to have, children.” In the 2002 Barcelona Bill of Rights, ICW and other organizations stated that a fundamental right for women and girls around the world is “to sexual and reproductive health services, including access to safe abortion without coercion.” So is reproductive choice receiving attention at the AIDS conference?

Some state that it was scarcely addressed; that is certainly true, for example, in comparison to prevention of perinatal transmission. But a few small steps forward have been made if we consider that the topic was virtually ignored in the past. About 20 poster and CD-ROM abstracts included the topic of pregnancy termination or integration/linking of HIV/STI and abortion services; several called for access to safe abortion services or noted how current laws create obstacles for women.

Of course, many people will not read the abstracts and did not see the posters. So was the topic visible otherwise? The T-shirts given away to participants in the Women’s March and Rally (the first to be officially endorsed by an AIDS conference) featured the Barcelona Bill of Rights, including access to safe abortion. Buttons distributed by the ATHENA Network and Blueprint Coalition asked for “sexual rights, reproductive choice and healthy motherhood.” And in an opening plenary speech on the first day of the conference, Louise Binder highlighted the need for women to have access to safe abortion for all indications permitted by law. Now we need to ensure that the 2008 International AIDS Conference includes at least one oral abstract, round-table or panel discussion session on reproductive choice with discussion of issues such as antenatal care for women who choose to become pregnant after knowing their status, access to safe abortion and integration/linkage of postabortion care services into HIV/AIDS information and services, coercive abortion/sterilization as human rights violations, and the possibility of adoption for HIV-positive parents.

One final observation: Louise’s plenary was the final one on 14 August and previous speakers had exceeded their allotted time. This resulted in many delegates leaving the session to go to the next one; considerable numbers of women also left the room before hearing the presentation on women and HIV/AIDS. When her presentation went a bit long, the chair of the session (a woman!) cut off her microphone. To her credit, however, Louise stood her ground, refused to budge and was supported by remaining delegates so that eventually her microphone was turned back on and she could finish. The most insulting thing about this was the chair’s admonition that Louise had to conclude because the next session was about to start and included “important people – Bill Clinton and Bill Gates.” Now what does that say to us about women having a fully recognized and meaningful place at the table??

Some references:

ATHENA Network: http://www.athenanetwork.org

ICW press release on testing: http://www.icw.org/node/211Ipas study: http://www.ipas.org/publications/en/MDGMON_E06_en.pdf

News Health Systems

Texas Anti-Choice Group Gets $1.6 Million Windfall From State

Teddy Wilson

“Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services," Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement.

A Texas anti-choice organization will receive more than $1.6 million in state funds from a reproductive health-care program designed by legislators to exclude Planned Parenthood

The Heidi Group was awarded the second largest grant ever provided for services through the Healthy Texas Women program, according to the Associated Press.

Carol Everett, the founder and CEO of the group and a prominent anti-choice activist and speaker, told the AP her organization’s contract with the state “is about filling gaps, not about ideology.”

“I did not see quality health care offered to women in rural areas,” Everett said.

Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement that it was “inappropriate” for the state to award a contract to an organization for services that it has never performed.

“The Heidi Group is an anti-abortion organization, it is not a healthcare provider,” Busby said.

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State lawmakers in 2011 sought to exclude Planned Parenthood from the Texas Women’s Health Program, which was jointly funded through federal and state dollars. Texas launched a state-funded version in 2013, and this year lawmakers announced the Healthy Texas Women program.

Healthy Texas Women is designed help women between the ages of 18 and 44 with a household income at or below 200 percent of the federal poverty level, and includes $285 million in funding and 5,000 providers across the state.

Bubsy said the contract to the Heidi Group was “especially troubling” in light of claims made by Everett in response to a recent policy requiring abortion providers to cremate or bury fetal remains. Everett has argued that methods of disposal of fetal remains could contaminate the water supply.

“There’s several health concerns. What if the woman had HIV? What if she had a sexually transmitted disease? What if those germs went through and got into our water supply,” Everett told an Austin Fox News affiliate.

The transmission of HIV or other sexually transmitted infections through water systems or similar means is not supported by scientific evidence.

“The state has no business contracting with an entity, or an individual, that perpetuates such absurd, inaccurate claims,” Busby said. “Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services.”

According to a previous iteration of the Heidi Group’s website, the organization worked to help “girls and women in unplanned pregnancies make positive, life-affirming choices.”

Texas Health and Human Services Commission spokesperson Bryan Black told the Texas Tribune that the Heidi Group had “changed its focus.”

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” Black said in an email to the Tribune.

Its current site reads: “The Heidi Group exists to ensure that all Texas women have access to quality health care by coordinating services in a statewide network of full-service medical providers.”

Everett told the American-Statesman the organization will distribute the state funds to 25 clinics and physicians across the state, but she has yet to disclose which clinics or physicians will receive the funds or what its selection process will entail.

She also disputed the criticism that her opposition to abortion would affect how her organization would distribute the state funds.

“As a woman, I am never going to tell another woman what to tell to do,” Everett said. “Our goal is to find out what she wants to do. We want her to have fully informed decision on what she wants to do.”

“I want to find health care for that woman who can’t afford it. She is the one in my thoughts,” she continued.

The address listed on the Heidi Group’s award is the same as an anti-choice clinic, commonly referred to as a crisis pregnancy center, in San Antonio, the Texas Observer reported.

Life Choices Medical Clinic offers services including pregnancy testing, ultrasounds, and well-woman exams. However, the clinic does not provide abortion referrals or any contraception, birth control, or family planning services.

The organization’s mission is to “save the lives of unborn children, minister to women and men facing decisions involving pregnancy and sexual health, and touch each life with the love of Christ.”

Roundups Politics

Campaign Week in Review: Clinton and Sanders Tweet Against Anti-Choice Measure

Ally Boguhn

The candidates used social media to call on Florida Gov. Rick Scott to veto anti-choice legislation.

Clinton and Sanders Tweet Criticisms of Anti-Choice Legislation

Presidential candidates Hillary Clinton and Sen. Bernie Sanders (D-VT) took to Twitter this week to speak out against anti-choice legislation and to urge Florida Gov. Rick Scott (R) to veto legislation targeting reproductive rights. 

In a series of tweets signed “-H,” indicating that they come from the candidate herself, Clinton wrote that “States like Ohio, Utah, and Florida that attack Planned Parenthood are attacking women’s health, and they’re part of a dangerous trend.” The Democratic presidential candidate noted that if “efforts to roll back women’s rights seem relentless, you’re right: States have enacted 282 abortion restrictions since 2010.”

Clinton called on Scott to “do the right thing and protect a woman’s right to make her own health decisions,” referring to an opportunity to veto anti-choice legislation passed Wednesday by the Florida’s GOP-majority state senate. The measure would force doctors who offer abortion care to have admitting privileges at local hospitals and ban abortion clinics from receiving state funding for cancer screenings, HIV testing, and other forms of preventative care.

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The medical community has called admitting privileges laws medically unnecessary. Anti-choice legislators and activists characterize these laws as safety measures for pregnant people, though an anti-choice leader outside the Supreme Court this month said that admitting privilege laws are designed to destroy abortion care access.

Meanwhile, Sanders’ campaign in a Wednesday tweet flatly called on Scott to “veto this bill. Don’t play politics with abortion.”

“This is not about abortion services,” Barbara Zdravecky, CEO of Planned Parenthood of Southwest and Central Florida, said of the bill, according to the Orlando Sentinel. “This is about contraception, STD diagnosis and treatment, cancer screening, pap smears. They’re taking that all away.”

Trump: ‘”I Think Islam Hates Us”

Donald Trump doubled down on the comments he made about Islam earlier this week during Thursday night’s Republican presidential debate, charging that Americans should be wary of Muslim “hatred” of the United States.

“I think Islam hates us. There’s something thereit’s a tremendous hatred,” Trump said Wednesday, speaking with CNN’s Anderson Cooper. When pressed by Cooper to clarify whether that hatred was “in Islam itself,” Trump replied that, “you’re gonna have to figure that out, OK?”

CNN debate moderator Jake Tapper again pressed the issue with the leading Republican candidate, asking if his comments referred to “all 1.6 billion Muslims.”

“I mean a lot of them,” Trump replied.“There’s something going on that maybe you don’t know about, maybe a lot of other people don’t know about, but there’s tremendous hatred. And I will stick with exactly what I said to Anderson Cooper.”

Trump returned to the topic after Sen. Marco Rubio (R-FL) criticized his comments, asserting once again that “there is a tremendous hate” in Islam.

“There is tremendous hate. Where large portions of a group of people, Islam, large portions want to use very, very harsh means,” Trump said.  “Let me go a step further. Women are treated horribly. You know that. You do know that. Women are treated horribly, and other things are happening that are very, very bad. … The question was asked, what do you think? I said, there is hatred. Now it would be very easy for me to say something differently. And everybody would say, oh, isn’t that wonderful.”

Trump’s assertion comes months after he called for a “total and complete shutdown of Muslims entering the United States” in the aftermath of attacks in Paris and San Bernardino, California. Trump justified his stance by similarly claiming that there is a “great hatred towards Americans by large segments of the Muslim population.”

What Else We’re Reading

Mother Jones analyzes the Democratic presidential candidates’ positions on abortion rights later in pregnancy, finding that although Sanders is against restrictions on abortion access, Clinton’s position isn’t as clear.

Meet Lucia Quiej: The Guatemalan immigrant mother who questioned Democrats about family reunification during Wednesday night’s debate.

The Washington Post profiles Donald Trump’s sister, the “tough, respected federal judge Ted Cruz called a ‘radical pro-abortion extremist.’”

Bernie Sanders lent his support to destigmatizing breastfeeding this week. After a photo showing a Sanders supporter breastfeeding at a campaign rally gained attention, the Sanders campaign tweeted that “As a society, we should never stigmatize women for breastfeeding in public.” The woman in the photo wrote on Facebook that after the rally, “Bernie and Jane O’Meara Sanders both thanked me for doing what mothers do and taking care of my daughter when she needed her mom, even if that meant nursing in public!”

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