Part of RH Reality Check’s coverage of the International AIDS Conference, 2012.
On the whole, did the 2012 International AIDS Conference reflect the human rights-based and gender perspective necessary to addressing the epidemic among women and girls? There was a welcome emphasis on integrating family planning and HIV-related services, as well as reiteration on providing all HIV-positive women presenting for antenatal and post-partum care with lifelong antiretroviral therapy (ART). And some sessions focused on the need to assist women living with HIV in pre-conception planning so that they can determine when and how to guarantee the safest pregnancy and delivery possible. And finally, well-deserved and overdue attention was given to human rights violations involved in forced and coerced sterilization of and abortion among HIV-positive women.
What is striking about these contributions to the “AIDS discourse,” however, is their emphasis on women and girls primarily in their social role as mothers. Addressing women outside the motherhood paradigm – planning for and bearing a child – did not seem to be considered of equal importance.
For example, numerous speakers in sessions on the integration of reproductive health and HIV-related services pointed to high rates of unintended pregnancies among women and girls living with HIV, and called for urgent attention to increased access to contraceptive methods, including longer-acting methods. At the same time, there was little or no mention of what women should do when they are already faced with an unintended and unwanted pregnancy; access to emergency contraception and safe abortion was simply not mentioned. Nor was the provision of voluntary sterilization, although research and community work in Africa in which I have been involved reveals that women living with HIV who have requested voluntary sterilization have been denied access to this option.
During a session on addressing women’s pregnancy intentions, I mentioned that providing women with access to HIV testing and options for ART through venues other than antenatal care – e.g., services for survivors of violence, clinics for sexually transmitted infections, abortion-related care – is greatly needed. A delegate questioned why I would advise that since targeting women through antenatal care is an effective way of reaching women. My response was that it is not only pregnant women who need to be kept alive and healthy – all women living with HIV need this, whether they have children or not. And if we truly want to promote pre-conception planning, it is important that women already know their sero-status and the pros and cons of early treatment so that their decisions about when and how to give birth are well-informed. This means that women need to be targeted outside of antenatal programs.
This focus on women primarily as mothers was also reflected in the new guidance document issued by the Global Commission on HIV and the Law. The report addresses laws that criminalize and discriminate against people based on their HIV status, sexual orientation and gender identity, and involvement in sex work and drug use. During a presentation on the report, a Commissioner noted that it was decided to also include laws that discriminate against women, even though this had not been within the original remit of the Commission.
The report contains valuable information and some very good recommendations. However, while the section on women and the law addresses violence against women, property and inheritance rights, coerced and forced sterilization and abortion, it does not address criminalization of abortion and denial of safe abortion. When I asked about this, I was told the Commission didn’t want “to go too far afield” in the issues it was tackling. I pointed out that coerced abortion and denial of safe abortion are both violations of the reproductive rights of women living with HIV and expressions of gender inequality; denial of safe abortion is not “further afield” than coerced abortion. I was then told that the issue of criminal laws against abortion was discussed by the Commission but there was no consensus on including this topic so it was left out of the report.
It is noteworthy to consider that the Commission agreed to address other “sensitive” issues such as discrimination against drug users, sex workers, and people of various sexual orientations but not denial of safe voluntary abortion, which is an issue that only directly affects women. Again, a human rights violation was acknowledged when it was related to women’s desire to be mothers but not when it related to women who choose not to be mothers (or who are spacing or delaying childbirth for myriad reasons, including issues related to violence against women).
It was also interesting to note a recommendation in the Commission’s report stating that we must:
“promote effective measures to prevent violence against men who have sex with men.”
Why did this recommendation not say: “promote effective measures to prevent violence against men who have sex with men and women who have sex with women?” While the report gives ample attention to the need to address rape and violence against women, in particular marital rape, the phenomenon of corrective rape is not addressed in the same manner. Is this because it involves a violation of women’s rights outside the paradigm of motherhood and marriage?
To promote gender equality, gender equity, social justice, and sexual and reproductive rights of women and girls living with, and affected by HIV, it is important that guidance and advocacy emanating from the International AIDS Conference and norm-setting bodies, such as the Commission on HIV and the Law, are truly gender and human rights-based. Such a perspective requires addressing the comprehensive needs of women and girls, including those seen in areas that do not “conform” to the focus on motherhood and marriage.