Sex Workers Rights, HIV Infection, and Prevention: Parting Thoughts from the International AIDS Conference


This article is published in partnership with the International Women’s Health Coalition as part of a series of articles and opinion pieces on global AIDS and HIV in conjunction with the International AIDS Conference in Vienna, which ended this weekend.  We welcome vigorous policy debates on these and other issues.

The 2010 International AIDS Conference has come to a close. Throughout the week, I attended several sessions and workshops and met with both old and new partners, but three particular sessions made me think a lot.

Serodiscordant, Zero Difference
On Wednesday, July 21 at the IAC, I attended a session led by a personal friend and fellow activist. She has been living with HIV for 16 years, and her husband is HIV negative (referred to as “serodiscordant”). By telling their story, Ana and Bill were able to demonstrate to over 40 serodiscordant couples in the room that internalized stigma, guilt, and fear are very common–yet surmountable–barriers to a strong relationship.   Ana described the nervousness she felt about having unprotected sex with Bill, even just once.  The possibility of her infecting him was very minimal since she has been on highly active anti-retroviral treatment for over seven years, but transmission is always a possibility when partners are serodiscordant. She also has human papillomavirus (HPV), some strains of which can lead to cervical cancer. Ana and Bill talked about how protecting their health was their priority, as was having constant communication about their fears, dreams, and challenges. Ana said: “Before I married Bill, I was HIV positive. It was my life, my body, my choice. Today, it is OUR lives. We are serodiscordant, but there is zero difference- in a relationship, in care, in support”.

Vertical Transmission- Is it about women, women and children, or infants?
Only in the last two years has the prevention of vertical transmission of HIV (commonly known as prevention of mother to child transmission, or PMTCT) been a priority. In Thursday’s plenary session, Elaine Abrams from Columbia University outlined what was needed to save the lives of women and children. Although I completely agree that avoiding vertical transmission is vital to the health and wellbeing of women and their newborns, programming for vertical transmission in the name of “women” is a misnomer. The four-pronged approach to comprehensive PMTCT programs include “preventing HIV infection in women” and “preventing unintended pregnancies,” yet these programs often focus on the biomedical-focused third prong: providing single doses of the drug nevirapine to women during pregnancy to prevent transmission of the virus to the fetus. If we truly want to invest in women’s health within the HIV/AIDS response, the first prong of PMTCT must be tackled head-on, including by providing women with the comprehensive package of sexual and reproductive health services- contraception, maternity care, safe abortion, STI/HIV testing and treatment. Programs must also respect, protect, and fulfill women’s human rights, including their sexual and reproductive rights.

Unfortunately, this was not a focus of Abram’s presentation. If it had been, perhaps we would have more success in the push towards “combination prevention.”

SANGRAM’s Bill of Rights
Meena Seshu, of IWHC’s partner organization SANGRAM and one of my gurus, delivered the Jonathan Mann Human Rights Lecture Thursday. Through a series of short videos, anecdotes, personal histories, and people’s stories and voices, Meena spoke truth to power. She made a call to action so that everyone in that room will think of SANGRAM’s Bill of Rights when designing and implementing HIV and AIDS programs. Check out a video of Meena and more from her speech and the SANGRAM Bill of Rights in our Akimbo post No Excuses: A Living Experience of the Struggle for Rights.

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