HIV-positive women—like all women worldwide—have the right to decide when and if to have children. To make this right a reality, all women need access to comprehensive sexual and reproductive health (SRH) information and services. Women make up about half of all people living with HIV worldwide and most of these women live in low- and middle-income countries.
Despite global declines in infection rates and an increased global response to the epidemic, HIV-positive women have unmet SRH needs, as evidenced by high rates of unintended pregnancy and unsafe abortion in HIV-prevalent countries and HIV treatment programs. Integrating comprehensive SRH care, including family planning and safe abortion care, into HIV prevention, care, and treatment services is an important way to ensure HIV-positive women have the information and tools they need to make informed reproductive choices and improve their overall health.
Efforts to integrate SRH services with HIV prevention, care, and treatment have become a priority in many health care settings. The benefits of integrating health care services are many, including increasing access to and uptake of services, and improving the quality of care. To date, integration research and programs have largely focused on including family planning and prevention and management of sexually transmitted diseases in HIV prevention, care, and treatment services (or vice versa), but often do not address positive women’s comprehensive SRH needs.
Notably, many HIV and SRH interventions perpetuate stigma associated with abortion and limit access by neglecting to include abortion care or referrals into information and services for HIV-positive women. Furthermore, the persistence of US government policies that restrict funding to groups that provide or refer to abortion care severely limits organizations’ abilities to integrate HIV and SRH services. This failure to address HIV-positive women’s need for information about and access to abortion care and the unique barriers to safe abortion access that they face, persists even in settings where abortion is legal, or available under certain circumstances.
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Research shows that HIV-positive women seek abortions for many of the same reasons other women do, but also that HIV-positive status can raise unique issues, such as fear about how a pregnancy will impact a woman’s health, and concerns about transmitting HIV during pregnancy. Furthermore, due to legal and financial barriers, women living in HIV-prevalent countries may lack access to safe abortion services or face discrimination in accessing abortion care because of stigma and fear surrounding HIV and AIDS. While there is limited clinical research on abortion provision for HIV-positive women, our review of the available clinical data suggests that both aspiration and medical abortion are appropriate and safe options for women living with HIV.
Efforts aimed at integrating abortion services into HIV and SRH services are critical to protecting and promoting the reproductive health and rights of HIV-positive women. In a guide on good practices on integration of HIV and SRH, the International HIV/AIDS Alliance names abortion as a key HIV and SRH intervention and outlines strategies for how to integrate safe abortion and post-abortion care into HIV services. Advocates for HIV-positive women should build on these recommendations and the momentum generated by the recent report from the United Nations Special Rapporteur on the Right to Health that calls for the removal of legal barriers to access to abortion for all women to improve women’s health worldwide.
In order for HIV-positive women to be able to exercise their right to decide when and if to have children, we believe that, at a minimum, non-biased pregnancy options counseling and referrals to safe abortion and/or post-abortion care services should be part of comprehensive SRH services provided to HIV-positive (and all) women. On this World AIDS Day, we call for an expansion of efforts to integrate family planning and HIV prevention, treatment, and care to incorporate information on and (where possible) referrals to safe abortion services as critical components of comprehensive SRH care for HIV-positive women. Access to and information about safe abortion should be available to all women so they can lead fulfilling and safe sexual lives, fully exercise their reproductive rights, and protect their reproductive health.