U.S. Policy Ignores the Reproductive Rights of HIV-positive Women

Brook Kelly

The U.S. National HIV/AIDS Strategy fails to address and promote the reproductive rights of HIV-positive women beyond the limited goal of reducing mother-to-child transmission.

Wednesday, December 1st, 2010, is World AIDS Day.

Today is World AIDS Day  – a day of remembrance for those who have passed and a celebration of achievements gained in the course of the past year. The theme for 2010 is “take action to tackle HIV prejudice and to protect yourself and others from HIV transmission.”  This year has seen huge strides in the effort to diminish prejudice and stigma against people living with HIV in the U.S. The Obama administration released the first U.S. National HIV/AIDS Strategy in July.  The Strategy addressed head on the effects of stigma and discrimination on the health of HIV-positive people by making reduction of stigma and discrimination against people living with HIV a key step in reducing HIV-related disparities and health inequities.

Yet there was little mention of HIV-positive and HIV-affected women in the government’s analysis and plans for future campaigns to reduce stigma and health disparities for people living with HIV.  Over the past year the U.S. Positive Women’s Network conducted a human rights survey through which we asked women about their experiences with HIV testing and disclosure, reproductive health and rights, and HIV criminalization.  What we found was profound and persistent discrimination and stigma against women living with HIV, especially in the areas of reproductive health and choice. 

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A majority of women diagnosed with HIV learn of their HIV status during their reproductive years, yet few receive up to date information on their reproductive options and health from healthcare providers.  One woman wrote:

“I seemed to be the educator in most of these areas [of being HIV-positive and wanting to have a child]. I was more up to date on the information than any doctor I found.”

The right to decide when and whether or not to have a child

Others wrote of hurtful treatment and incomplete, inaccurate and out of date information leading to coerced reproductive decisions.  One respondent wrote:

“I was pregnant at the time of my test, and was urged to abort that child, which I did, reluctantly, but they told me that my child would be HIV-positive for sure, if I carried it to term.” 

In some parts of the U.S. health department the violation of HIV-positive women’s fundamental right to start a family is part of official policy and practice.  The Mississippi State Department of Health, for example, uses a form last updated in 2009, requiring people who test HIV-positive to sign their initials next to the requirement to understand the “necessity of not causing pregnancy or becoming pregnant,” among other restrictions.

In spite of incredible medical achievements that make it possible for HIV-positive women to live long and healthy lives and give birth to healthy children, medical and health provider prejudice and misinformation persists.  

Yet the most sweeping and cutting-edge framework for addressing the HIV epidemic in the U.S., the U.S. National HIV/AIDS Strategy, entirely failed to mention women’s reproductive needs beyond the reduction of mother-to-child transmission.  When the U.S. Positive Women’s Network in partnership with 12 other organizations analyzed and graded the National AIDS Strategy from a gender perspective the Strategy received a C+. The Strategy does not mention HIV-positive women’s reproductive health and rights and fails to address the barriers that medical practitioners continue to face in integrating reproductive and HIV care due to siloed funding structures.   

There is much work to be done to tackle prejudice against women living with HIV.  Women living with HIV who have the expertise of experience must lead the way and be joined by strong partners in the HIV/AIDS community.  But these two groups cannot do it alone. We will need to reach out to our partners in the reproductive rights and justice, and civil and human rights communities to learn from their successes and challenges and work toward creating a broader coalition of people to ensure all women have reproductive justice. 

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