Linking HIV/AIDS with sexual and reproductive health and rights

KC JOURNAL NO 20 November 2008

In this article Stevens critically discusses the predominance of funding for HIV/AIDS at the neglect of other important and related areas affecting women’s health.

The 1990s was the decade of Cairo and Beijing, the two United Nations conferences that led to new and progressive international agreements on women. At that time, South Africa responded by developing and implementing similar progressive changes.

Women & health

Because of the changes in the international arena, the international agreements affecting women in particular were met with national changes in funding allocations and in programming in sexual and reproductive health and rights. In 2007 the non-governmental organisation Oxfam reviewed violence against women. In the review, the authors reflected the opinion that ‘women’s health had become reduced to HIV’.

HIV/AID and Funding

It is a harsh reality that HIV/AID infects and affects women greatly. Of those infected, the majority are women, and women bear the load in care-giving for the affected given entrenched gender relations in our society. Funders and programmers have embraced the HIV agenda enthusiastically. It is the field with the biggest money flows.

Civil society has had to adapt to survive and sustain our agenda of advancing women’s health. A clear example of this is the Reproductive Health Research Unit, which has amended its focus and its name to the Reproductive Health and HIV/AIDS Research Unit. At the same time these international agencies have influenced our agenda in a constricting way. The proposals that we submit are expected to exclude work on abortion, sex workers and men who have sex with men. This has resulted in a growing AIDS treatment movement which does not want to engage in sexual and reproductive health and rights issues. Given the complexity of treatment in South Africa, the way to get a foot in the door with antiretroviral (ARV) treatment was to start with the ‘prevention of mother to child transmission (PMTCT) of HIV’.

This was the start of ARV treatment in South Africa. But if we stop a moment to reflect, it is important to consider how it has panned out. While not the intention of the treatment movement, the focus on the prevention of mother to child transmission of HIV has put in place ARV treatment for unborn babies but not for their mothers. In some reports, the language used to describe PMTCT is similar to that of the anti-choice groups. There is a lot of emphaisis on ‘saving the unborn child’. There are attempts to include treatment for the pregnant woman, but it is not the over-riding assumption. Some doctors are still debating the policy of the World Health Organisation and South Africa’s health department about when it is acceptable to start highly active ARV therapy (HAART) with women and pregnant women given the difficulties of patient adherence issues.

Language

The language of PMTCT has also reinforced an understanding that women spread HIV which is totally unhelpful. In many countries this language has been changed. The insistence of women activists in India has led to it being termed, ‘prevention of parent to child transmission’ (PPTCT) or the ‘prevention of vertical transmission’, as it was originally termed. Language shapes our reality and it is important to think about our choice of words.

Other related but neglected areas

Overall, sexual and reproductive health and rights as part of the continuum of care has been neglected. There is no an easy engagement between the HIV and the sexual and reproductive health and rights sectors.

For example, women do not regard being offered to choose to continue their pregnancy or terminate it as part of the continuum of care. What is understood is that you will get HIV treatment for your unborn baby and, if you are lucky and considered eligible, you may receive care. The option to terminate is not presented as part of the continuum of care.

There have been anecdotal reports of women resorting to illegal abortions due to this gap in care. On the other hand, as there is no policy combining HIV and sexual and reproductive health and rights concerns, there are anecdotal reports of health workers insisting that HIV positive women have abortions and sterilisations in KwaZulu Natal.

Other sexual and reproductive health and rights issues including appropriate contraception for HIV-positive women; including violence against women with the sexually transmitted infections syndromic management protocol; and screening for cervical cancer, which has been left outside what is considered the ‘treatment agenda’. Appropriate treatment for lesbian women and acknowledgment of the continuum of sexual and reproductive intentions that women engage in, is pretty much off the agenda.

As activists we need to reclaim this space.

a space for dialogue

Should you wish to participate in these debates and organised activities you may want to subscribe to the 60percente-mail listserv on lyris@hst.org.za.

The command to use is ‘subscribe 60percent [Your Name]’. The list address is 60percent@hst.org.za. The list acknowledges by its name that we have a feminised HIV/AIDS epidemic. Within southern Africa 60 percent of those infected are believed to be women. While the South African National Strategic Plan suggests that 55% are infected, actuarial modelling suggests that this is an underestimate.

The list is a safe and respectful space to dialogue on HIV/AIDS through a gender, women’s rights and sexual and reproductive health and rights lens with the continuum of prevention, treatment and care in mind.

The serve has been created as a result of discussions with the AIDS Legal Network, the Democratic Nursing Association of South Africa, Health Systems Trust, Ipas South Africa, Mosaic Healing and Training Centre for Women, OUT LGBT, Tshwaranang Legal Advocacy Centre, Women’s Net and the International Community of HIV Positive Women. This group forms the reference group for the list.


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