Since the 2006 Toronto International AIDS Conference, an increasing number of organizations have spoken out about the need to respect the reproductive rights of women living with HIV/AIDS. In many instances, however, the focus has been primarily on three issues: access of HIV-positive women to modern contraceptive methods, condemnation of forced sterilization and coerced abortions, and HIV-positive women's right to bear children safely through measures to prevent perinatal transmission.
A topic that is often neglected - or avoided - has been enabling HIV-positive women to deal with unwanted pregnancies through emergency contraception and voluntary safe legal abortion. So how was the topic covered at the Mexico AIDS conference? A quick scan of the conference program (which may admittedly have omitted some references) shows that of the 7309 abstracts on the conference CD-ROM, about 50 addressed pregnancy termination in some way.
About 21 abstracts reported on abortion rates in relation to pregnancy outcomes - a large proportion of these studies referred to sex workers, with only a few focused on women living with HIV. One abstract mentioned stigmatization of HIV being increased due to its association with pollution and abortion in South Africa; a few also mentioned forced abortion as a human rights violation.
A handful of research reports incorporated abortion as a study topic. Barbosa et al. compared access of HIV-positive and HIV-negative women to abortion services in Brazil. They found that women living with HIV more often had abortions (and tubal ligations) but they did not present information on why this might be the case. The Women's Health Research Unit from the University of Cape Town, South Africa, reported on interview studies with people living with HIV and health-care providers, concluding that "tailored contraception, preconception, and termination of pregnancy counselling may be critical to helping HIV+ women and men...make informed decisions that optimize the reproductive health outcomes for them as well as their future children." Nevertheless, Ruth Borms reported that even in Europe, where abortion is permitted by law, health-care providers seldom discuss pregnancy termination with HIV-positive clients.
While voluntary pregnancy termination was scarcely addressed at previous AIDS conferences as a policy issue, several speakers addressed the need to include abortion care within the scope of reproductive rights. Notable examples: Morolake Odetoyinbo (GNP+, Nigeria) stated that prevention of unsafe abortion, treatment of miscarriages and postabortion care are special needs of HIV-positive women. Shaun Mellors (International HIV/AIDS Alliance), Marion Stevens (Health Systems Trust, South Africa), Kalindy Bolivar (Coordinadora Juvenil por la Equidad de Género, Ecuador), and Elizabeth Maguire (Ipas) reflected on the need to include both safe motherhood and safe pregnancy termination as services for women living with HIV. Zonny Woods, who spoke in the closing plenary on the needs of women and girls, also mentioned the need to include safe abortion as a reproductive right for HIV-positive women.
These presentations were encouraging steps forward, but much remains to be done to overcome the stigma and taboos attached to the issue. I was able to attend a couple panels on integration of HIV/AIDS and reproductive health services; what was striking about some of those presentations was that abortion was presented as an obstacle and a problem to be overcome in promoting linkages and integration, not as a right that women living with HIV should have so that they can deal with unwanted pregnancies.
Ipas and the Health Systems Trust offered a Global Village session on "Linking HIV and reproductive choice - reflecting on strategies for advocacy," the first time that pregnancy termination was a workshop topic. We started off with 24 participants but when it became clear that we would talk specifically about abortion care, many people left. Debbie Billings remarked: "Unwanted pregnancy among positive women is a reality that hardly is discussed. The workshop that I attended was one of the few spaces in the conference where abortion as an option was addressed. It was disappointing to see so many participants leave the workshop just as we broke into small groups to strategize how to disseminate messages about positive women's reproductive rights. The topic of abortion seemed to make many people uncomfortable, so much so that they had to leave the session."
Our advocacy for the rights of women living with HIV to become mothers has definitely advanced in recent years - we are talking about their right to bear children, to use assisted conception and to adopt children. Hopefully, the right of HIV-positive women to avoid unwanted pregnancies will become as accepted an issue at the next AIDS conference in 2010, not only in presentations on policy needs but also sessions discussing interventions and linkages between HIV/AIDS and reproductive health services.
