Like all women and men, people living with or at risk of acquiring HIV have the right to determine the number and timing of their children and to safely achieve their reproductive intentions. Yet many women and couples affected by HIV lack access to family planning (FP) services and experience disproportionately high rates of unintended pregnancy and abortion. Why is this so? One major challenge is that myths, misinformation, and stigma with regard to the sexual and reproductive health (SRH) rights of people affected by HIV continue to persist among healthcare workers.
Research has shown that healthcare providers often have poor knowledge, attitudes, and behavior with regard to providing contraception to clients affected by HIV. For example, they often (incorrectly) emphasize condoms as the sole FP option appropriate for these women and couples. Moreover, most do not routinely discuss the importance of dual method use, offer other more reliable contraceptive method options, or provide emergency contraception.
Additionally, studies with clients of HIV services have illustrated the challenges they experience with receiving care that respects their fertility intentions and reproductive rights. Women living with HIV from South America, Africa, and Asia have reported being encouraged to avoid pregnancy or to undergo sterilization or abortion by their healthcare providers because of their HIV status [1,2,3].
These types of limited, biased, or coercive fertility discussions not only result in unmet healthcare needs, but are violations of fundamental reproductive rights. So what can be done to address this challenge? One critically important strategy is to tackle biases and stigma in the health system by offering sensitization and training for providers on the comprehensive SRH of women and couples affected by HIV. Two essential elements for these interventions include:
- Orienting providers to the SRH rights of people living with HIV and what rights-based health care entails; and
- Ensuring that providers from a variety of HIV service settings are able to counsel on the full spectrum of FP services, including safer conception and pregnancy, as well as the range of safe and effective contraceptive methods for clients living with HIV.
These types of targeted efforts will help fulfill the right that all women, men, and couples have to high-quality, comprehensive SRH care free of stigma and discrimination.
1. Forced Sterilization Preys on Women Living with HIV/AIDS. Center for Reproductive Rights. 2012.
2. Forced Sterilization of HIV Positive Women Continues in Southern Africa. International Women’s Health Coalition. 2010.
3. Positive and Pregnant – How Dare You: A study on access to reproductive and maternal health care for women living with HIV in Asia (Findings from six countries: Bangladesh, Cambodia, India, Indonesia, Nepal, Vietnam). Women of the Asia Pacific Network of People Living with HIV. 2012.