Coming from a family planning/reproductive justice background, I am very interested in the integration discussion going on at the International AIDS Conference regarding sexual and reproductive health and HIV/AIDS. The divide between the reproductive rights movement and the HIV/AIDS movement is counterproductive and does not deal with realities on the ground. I have been bothered by the lack of communication and cooperation between the two communities and interested in bridging the gap.
So, when I read the abstract for a session on the sexual and reproductive health of people living with HIV and AIDS, put on by the Guttmacher Institute, I was intrigued. The panel included four presenters, two from the US, one from Nigeria, and one from Zimbabwe. I went to the session hoping to hear about true integration of reproductive rights and HIV/AIDS movements. Instead, I was disturbed by the lack of understanding between the two movements. A theme ran through the presentations, given by the US-based colleagues, which was both incredibly problematic and incredibly enlightening.
Both of these presentations addressed contraception as an HIV prevention method, rather than contraception as a family planning option for HIV-positive women. In fact, one of the presentations, "contraception as a way to prevent HIV," directly followed the presenter from Nigeria, a woman living with HIV who spoke movingly about the lack of access to comprehensive support for women living positively, including lack of adoption options and support for women choosing to have children. Just seeing the title slide from the subsequent presentation made me nervous: was this presentation going to be about stopping HIV positive women from having children?
As stated by the woman from Nigeria, one of the largest obstacles in the fight against HIV is the lack of access to information and commodities, such as contraceptive options, for vulnerable populations. However, this lack of family planning options should not be treated as a cause of HIV infections, but as another symptom of the marginalization of groups such as youth, women, those below the poverty line, injection drug users, men who have sex with men, and sex workers. A strategy around providing sexual and reproductive health services, including family planning, to these vulnerable populations is important to the AIDS movement because it provides information and access, empowers them to make healthy sexual choices in their own lives, and can help decrease stigma and prejudice, all pieces of what makes members of these communities more at risk for HIV. But most of all, sexual and reproductive health services should be important to the HIV/AIDS movement because they are a basic human right.
I'm sure the US-based presenters would agree with everything I just wrote. However, the way they framed the connection between family planning access and HIV/AIDS was much different. One presentation connected access to family planning and HIV prevention by emphasizing the importance of contraception in preventing unwanted, HIV-positive children. It was argued, with scant evidence, that women who are HIV positive are more likely to have unintended pregnancies and that the focus has been too much on preventing mother-to-child transmission once a woman is pregnant. This framing is, first of all, incorrect because it gives the impression that preventing the unintended pregnancies of HIV-positive women is more important than preventing the unintended pregnancies of negative women, simply because these women are HIV positive. Second, it is insensitive to women living with HIV and AIDS, a population that has more often than not been told they should not reproduce rather than told they can.
As the moderator and final presenter had an opportunity to change the framework around sexual and reproductive health and people living with HIV and AIDS to one about basic human rights, she only repeated this problematic framework. All in all, I was disheartened.
This problem reminds me of one we have been dealing with in the reproductive justice movement for years; the language around the choice of not having a child does not resonate for populations who have experienced forced sterilization, been coerced into having fewer children, or marginalized. It does not resonate for many women of color in America and it does not resonate with people living with HIV and AIDS.
I have been so excited about the change from a "pro-choice" framing to a reproductive justice framing in the past couple years because I thought that it represented a shift in the way we talk about family planning to a way that makes sense for all populations. I was extremely disappointed that this framing was missing when it came to talking to the HIV/AIDS community. Reproductive justice is inclusive and when it comes to HIV-positive people, is something we need to incorporate into our framing. If we stand for basic human rights, we should stand for the rights of those living with HIV and AIDS, not because we hope they will have fewer children, but because they also deserve sexual and reproductive health and justice.
