Sorry, Those Aren’t Your Rights: HIV-Positive Namibian Women Face Coerced Sterilization

Aziza Ahmed and Jennifer Gatsi-Mallet

For Namibian HIV positive women who need to access health services for their survival, hospitals should be a place of safety, not stigma, coercion, or forced sterilization.

Several of my colleagues from the International
Community of Women Living with HIV/AIDS (ICW)
and I were crammed into an
SUV with our luggage and food driving through the northern regions of
Namibia.  It was a trek familiar to
Jennifer Gatsi-Mallet, ICW Namibia Country Officer, and Veronica Kalambi, an ICW
member.   This was a journey they had made
many times while visiting the many women and girls who come to positive women’s
support group meetings throughout the country. 
For the rest of us, it was our first time to rural Namibia and the
Namibia-Angola border. 

The trip we
were making was in response to a shocking discovery by Jennifer during a
Namibian Young Women’s Dialogue that
several HIV positive women in Namibia had been sterilized against their
consent.  More inquiry into the situation
by ICW Namibia and the Namibian Women’s Health Network determined that there
was a need to do a fact-finding mission to gather data and take steps to demand
justice from those individuals and entities that had violated the sexual and
reproductive rights of women.  These
fundamental rights include the rights of HIV positive women to have a safe,
healthy, and fulfilling sex life and to determine whether and when to have
children.  They also include the right to
access health services free of stigma and discrimination; the right to full
information about health services and conditions; the right to give full
informed consent before any medical procedure; and the right to access to
prevention of mother-to-child transmission services. 

Members of ICW know all too well the terrible and
traumatic experiences faced by HIV-positive women as they attempt to access
care, treatment, and support in general, and with specific regard to sexual and
reproductive health services.  However,
knowledge and awareness is never preparation enough for the traumatic and
extreme rights violations that we were now documenting in Namibia.  

As we asked questions: have you ever been mistreated in a
hospital? Have you been forced to accept a procedure you did not want? Women
raised their hands time and time again, speaking of poor treatment by nurses and
physicians, telling of being kept in separate waiting areas because they were HIV
positive, and being identified as HIV positive in front of other patients.  Alongside stigma and discrimination, women spoke
of being made to feel that because they are HIV positive they should not be
pregnant, and about receiving misinformation about pregnancy and HIV. Positive women
spoke of their rights to information and informed consent being violated: For example, some were encouraged to take birth control
despite desiring more children, others were forced and coerced into sterilization while
in labor or while having a caesarian section.  
We visited hospitals and spoke to staff that admitted the mistrust they
have for women when it comes to caring for their own bodies.  One physician even spoke of the women who
visit his clinic as being unclean and poor and unable to make the best decisions
for themselves, their bodies, and their communities.   

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ICW has partnered with several domestic and international
NGOs in order to seek justice for the women who have been sterilized and demand
that necessary changes be made to stop the violations of women’s sexual and
reproductive health and rights.  All are
rights protected by the Namibian Constitution as well as regional and
international human rights agreements. 

For HIV positive women who need to access health services
for their survival, a hospital should be a place of safety, a place where one
recuperates, and where one can fully understand and address the health issues
that affect them. In other words, hospitals and health care facilities are a
place where rights should be realized, not violated.   As
documented by ICW
, health care facilities as sanctuaries of health and human
rights for HIV positive women in Namibia remain far from reality.

Commentary Sexual Health

Fewer Young People Are Getting Formal Sex Education, But Can a New Federal Bill Change That?

Martha Kempner

Though the Real Education for Healthy Youth Act has little chance of passing Congress, its inclusive and evidence-based approach is a much-needed antidote to years of publicly funded abstinence-only-until-marriage programs, which may have contributed to troubling declines in youth knowledge about sexual and reproductive health.

Recent research from the Guttmacher Institute finds there have been significant changes in sexuality education during the last decade—and not for the better.

Fewer young people are receiving “formal sex education,” meaning classes that take place in schools, youth centers, churches, or community settings. And parents are not necessarily picking up the slack. This does not surprise sexuality education advocates, who say shrinking resources and restrictive public policies have pushed comprehensive programs—ones that address sexual health and contraception, among other topics—out of the classroom, while continued funding for abstinence-only-until-marriage programs has allowed uninformative ones to remain.

But just a week before this research was released in April, Sen. Cory Booker (D-NJ) introduced the Real Education for Healthy Youth Act (REHYA). If passed, REHYA would allocate federal funding for accurate, unbiased sexuality education programs that meet strict content requirements. More importantly, it would lay out a vision of what sexuality education could and should be.

Can this act ensure that more young people get high-quality sexuality education?

In the short term: No. Based on the track record of our current Congress, it has little chance of passing. But in the long run, absolutely.

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Less Sexuality Education Today

The Guttmacher Institute’s new study compared data from two rounds of a national survey in the years 2006-2010 and 2011-2013. It found that even the least controversial topics in sex education—sexually transmitted diseases (STDs) and HIV and AIDS—are taught less today than a few years ago. The proportion of young women taught about STDs declined from 94 percent to 90 percent between the two time periods, and young women taught about HIV and AIDS declined from 89 percent to 86 percent during the same period.

While it may seem like a lot of young people are still learning about these potential consequences of unprotected sex, few are learning how to prevent them. In the 2011-2013 survey, only 50 percent of teen girls and 58 percent of teen boys had received formal instruction about how to use a condom before they turned 18. And the percentage of teens who reported receiving formal education about birth control in general decreased from 70 percent to 60 percent among girls and from 61 percent to 55 percent among boys.

One of the only things that did increase was the percentage of teen girls (from 22 percent to 28 percent) and boys (from 29 to 35 percent) who said they got instruction on “how to say no to sex”—but no corresponding instruction on birth control.

Unfortunately, many parents do not appear to be stepping in to fill the gap left by formal education. The study found that while there’s been a decline in formal education, there has been little change in the number of kids who say they’ve spoken to their parents about birth control.

Debra Hauser, president of Advocates for Youth, told Rewire that this can lead to a dangerous situation: “In the face of declining formal education and little discussion from their parents, young people are left to fend for themselves, often turning to their friends or the internet-either of which can be fraught with trouble.”

The study makes it very clear that we are leaving young people unprepared to make responsible decisions about sex. When they do receive education, it isn’t always timely: It found that in 2011-2013, 43 percent of teen females and 57 percent of teen males did not receive information about birth control before they had sex for the first time.

It could be tempting to argue that the situation is not actually dire because teen pregnancy rates are at a historic low, potentially suggesting that young people can make do without formal sex education or even parental advice. Such an argument would be a mistake. Teen pregnancy rates are dropping for a variety of reasons, but mostly because because teens are using contraception more frequently and more effectively. And while that is great news, it is insufficient.

Our goals in providing sex education have to go farther than getting young people to their 18th or 21st birthday without a pregnancy. We should be working to ensure that young people grow up to be sexually healthy adults who have safe and satisfying relationships for their whole lives.

But for anyone who needs an alarming statistic to prove that comprehensive sex education is still necessary, here’s one: Adolescents make up just one quarter of the population, but the Centers for Disease Control and Prevention estimate they account for more than half of the 20 million new sexually transmitted infections (STIs) that occur each year in this country.

The Real Education for Healthy Youth Act

The best news about the REHYA is that it takes a very broad approach to sexuality education, provides a noble vision of what young people should learn, and seems to understand that changes should take place not just in K-12 education but through professional development opportunities as well.

As Advocates for Youth explains, if passed, REHYA would be the first federal legislation to ever recognize young people’s right to sexual health information. It would allocate funding for education that includes a wide range of topics, including communication and decision-making skills; safe and healthy relationships; and preventing unintended pregnancy, HIV, other STIs, dating violence, sexual assault, bullying, and harassment.

In addition, it would require all funded programs to be inclusive of lesbian, gay, bisexual, and transgender students and to meet the needs of young people who are sexually active as well as those who are not. The grants could also be used for adolescents and young adults in institutes of higher education. Finally, the bill recognizes the importance of teacher training and provides resources to prepare sex education instructors.

If we look at the federal government’s role as leading by example, then REHYA is a great start. It sets forth a plan, starts a conversation, and moves us away from decades of focusing on disproven abstinence-only-until-marriage programs. In fact, one of the fun parts of this new bill is that it diverts funding from the Title V program, which received $75 million dollars in Fiscal Year 2016. That funding has supported programs that stick to a strict eight-point definition of “abstinence education” (often called the “A-H definition”) that, among other things, tells young people that sex outside of marriage is against societal norms and likely to have harmful physical and psychological effects.

The federal government does not make rules on what can and cannot be taught in classrooms outside of those programs it funds. Broad decisions about topics are made by each state, while more granular decisions—such as what curriculum to use or videos to show—are made by local school districts. But the growth of the abstinence-only-until-marriage approach and the industry that spread it, researchers say, was partially due to federal funding and the government’s “stamp of approval.”

Heather Boonstra, director of public policy at the Guttmacher Institute and a co-author of its study, told Rewire: “My sense is that [government endorsement] really spurred the proliferation of a whole industry and gave legitimacy—and still does—to this very narrow approach.”

The money—$1.5 billion total between 1996 and 2010—was, of course, at the heart of a lot of that growth. School districts, community-based organizations, and faith-based institutions created programs using federal and state money. And a network of abstinence-only-until-marriage organizations grew up to provide the curricula and materials these programs needed. But the reach was broader than that: A number of states changed the rules governing sex education to insist that schools stress abstinence. Some even quoted all or part of the A-H definition in their state laws.

REHYA would provide less money to comprehensive education than the abstinence-only-until-marriage funding streams did to their respective programs, but most advocates agree that it is important nonetheless. As Jesseca Boyer, vice president at the Sexuality Information and Education Council of the United States (SIECUS), told Rewire, “It establishes a vision of what the government could do in terms of supporting sex education.”

Boonstra noted that by providing the model for good programs and some money that would help organizations develop materials for those programs, REHYA could have a broader reach than just the programs it would directly fund.

The advocates Rewire spoke with agree on something else, as well: REHYA has very little chance of passing in this Congress. But they’re not deterred. Even if it doesn’t become law this year, or next, it is moving the pendulum back toward the comprehensive approach to sex education that our young people need.

CORRECTION: This article has been updated to clarify Jesseca Boyer’s position at the Sexuality Information and Education Council of the United States.

News Human Rights

Louisiana Is ‘Ground Zero’ for HIV, Incarceration Crises, Report Says

Kanya D’Almeida

Both of these epidemics disproportionately harm Black people, who account for 70 percent of new HIV infections in Louisiana and 66 percent of the state’s prisoners.

Thousands of prisoners in Louisiana’s county jails are routinely denied access to HIV testing and treatment, with five of the state’s 104 jails offering regular tests to inmates upon entry, according to a new Human Rights Watch (HRW) report.

The same people who are at the highest risk of HIV—people of color, sex workers, and low-income communities, for instance—face disproportionate incarceration rates in Louisiana, meaning that low-income people of color, and especially Black people, are bearing the lion’s share of the burden of inadequate HIV care in county jails, called “parish” jails in Louisiana.

Louisiana has the nation’s second highest rate of new HIV infections, and the country’s third highest rate of adults and adolescents living with AIDS, according to the report. The state has the highest incarceration rate in the nation, locking up an estimated 847 people per 100,000 residents, compared to the national average of 478 prisoners per 100,000 people. On any given day, there are roughly 30,000 people in Louisiana’s parish jails, contributing to an incarceration rate that is 150 percent of the national average.

Many of those whose treatment has been interrupted while in jail were arrested for minor, non-violent crimes, per HRW.

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Both of these epidemics disproportionately harm Black people, who account for 70 percent of new HIV infections in Louisiana (compared to 24 percent for white people), and 66 percent of the state’s prisoners—even though Black people account for 32 percent of Louisiana’s 4.6 million residents.

“This is not a coincidence,” Megan McLemore, a senior researcher at HRW and author of the report, told Rewire. “The history of the state of Louisiana has been, to say the least, disturbing in relation to African Americans.”

HRW interviewed more than 100 people for the report, from formerly incarcerated people to medical staff in parish jails to HIV service providers. What they found was a pattern of rights violations, including the failure of most parish jails to comply with recommendations by the Centers for Disease Control and Prevention that all inmates be tested for HIV upon entry at a corrections facility.

Jail officials reportedly told HRW that they avoid testing because they can’t afford to treat those who test positive: a course of medication for a single patient can fall in the range of $23,000-$50,000 per year. But the HRW report claims that failing to conduct proper testing, interrupting patients’ treatment plans, and neglecting to provide linkages to treatment centers for people leaving jails could end up costing the state much more in the long run.

Strict adherence to antiretroviral medication regimes has been found to greatly enhance successful management of HIV, the report said, by strengthening a person’s immune system and decreasing the amount of virus in the body, thereby reducing the risk of transmission. By denying inmates access to their medications, Louisiana’s parish jails are contributing to an already grave epidemic: the state is home to more than 20,272 people living with HIV, with half of them diagnosed with AIDS, according to the report.

Jail officials’ behavior heightens the stigma around HIV, advocates said. McLemore told Rewire that Louisiana’s inmate population represents some of the country’s most vulnerable and heavily policed communities.

“These are people who are already stigmatized—add HIV, and the situation becomes almost unbearable. So when jail officials intentionally avoid or neglect testing and treatment, they are not only adding to that stigma, they are actually being discriminatory,” McLemore said, adding that some caseworkers claimed their HIV-positive clients avoided disclosing their status to jail staff because they had no assurance that it would guarantee care.

Darren Stanley, a case manager at the Philadelphia Center in Shreveport, told HRW that half his clients have spent time in jail, and the majority of them are denied their medications on the inside. One of his clients, who spent three weeks in the Caddo Parish Prison in 2013, paid the ultimate price.

“I tried to get in touch with him but he was very sick without his medications,” Stanley told HRW. “He died of AIDS two weeks after he got out.”

A formerly incarcerated woman named Joyce Tosten who spoke to HRW claimed parish jail officers informed her that she would need to have her mother deliver any necessary HIV medications to the jail. But she couldn’t call her mother because she didn’t have phone privileges at the time. Other sources alleged that even when family or friends brought medications to the jail, they were never delivered.

The problem does not stop at incarceration. According to HRW, “release from parish jail is often a haphazard process consisting of whatever is left of their medication package, a list of local HIV clinics, or nothing at all.”

The report includes a series of recommendations such as setting aside adequate funding for HIV testing and care, training jail staff on effective treatment and management options, and strengthening links with local care providers and community-based centers for returning citizens.

Deon Haywood, executive director of Women With A Vision (WWAV), a New Orleans-based grassroots health collective responding to the HIV epidemic in communities of color, told Rewire that HRW’s recommendations were “spot on.”

“They speak to the conditions we have seen in the community for the past 26 years,” she said. “Through my work at WWAV and other New Orleans agencies, I’ve witnessed the failure of incarceration to better the community. We urge Louisiana to invest in education rather than criminalization, and shift the state’s resources and policies towards solutions that address the systematic inequalities that poor communities of color face on a daily basis.”

HRW’s report adds to a list of woes that Louisiana residents confront on a daily basis. The state recently ranked last on a nationwide index measuring social justice issues like poverty and racial disparities.

CORRECTION: This story has been updated to reflect Louisiana’s correct incarceration rate.