Reproductive Choices for HIV Positive Men and Women

Jayanti Hunter (14935167) - GRSJ224

People with HIV are often stigmatized and marginalized in society, in part, due to the stereotypes that exist about the lives of those with HIV. Many people expect HIV positive persons to be helpless and limited in their ability to perform daily tasks. HIV positive persons are often looked down upon because they are assumed to have had a promiscuous lifestyle which eventually lead to HIV. These hurtful stereotypes often force those with HIV to hide their diagnosis and, thus, they become shameful of themselves and their condition. In addition, many assume that HIV entails the end of a lineage. In essence, those infected with HIV should not and cannot have children.

Women are in an especially unfortunate position when it comes to the transference of HIV because the rate of transmission from male to female versus female to male is almost double. Making the rates of infection for women much higher in places where heterosexual sex is the most common. In addition, women are already seen as second class citizens in many parts of the world so the overlapping layers of injustice, discrimination, infection, and misogyny put women in a gravely disadvantageous position when dealing with HIV in a hegemonic male dominated society.

As of 2017, there are almost 40 million people living with HIV, in which, 1.8 million of those are children. Many of these HIV positive children were infected by their HIV positive mothers. Of those 40 million HIV positive people, the majority of them are of low to middle socioeconomic status, which means that the accessibility to healthcare is an even bigger challenge due to the overlapping disadvantages that exist for many of these HIV positive people. Furthermore, approximately 25% of those with HIV do not know they have HIV because they have not yet been tested for it, this means that there are women who are currently pregnant that could potentially have HIV without their knowledge, the same could happen with HIV positive men impregnating women. In order to safely conceive children while living with HIV, there needs to be more education and accessibility for reproductive options for HIV positive persons, but with so many low-income HIV positive persons, education and accessibility is far from met. Although many HIV positive persons are often preoccupied with getting the medication that they need in order to survive and live as normally as possible with HIV, there are still many who also need reproductive healthcare to safely conceive or abort a child. Unfortunately, the stigma that surrounds HIV/AIDS have prevented many of these people from receiving the healthcare and education that they need in order to safely conceive a child without transmitting HIV to the child. In addition, there needs to be more accessible HIV testing, fertility sites, and abortion sites for HIV positive persons.

Reproductive Choices

Many of the HIV positive people are in their reproductive years. Many of those in their reproductive years may still want children, have an unwanted pregnancy they need to terminate, or need a safe option for a contraceptive.

Fertility

For those seeking to bear children, UNAIDS recommends the use of HIV counselling and testing for those attending antenatal clinics. Fortunately, counselling in antenatal clinics has improved vastly in the last few decades, with many clinics offering voluntary HIV counselling and testing. However, the stigma that many face when wanting to have children is often what prevents women or men from going to fertility clinics, which prevents people from seeking help and education towards conceiving a child safely and with low risk.

Contraception

Current contraceptive options, such as; male/female condoms, oral hormonal pills, and IUD; are all effective for preventing pregnancies. However, the male condom is the most effective at minimizing risk of transmission.

Abortion

HIV positive women who have an unwanted pregnancy often lack the option for a safe abortion. Based on research done between 1999-2000, of all the reproductive options, an abortion was the least accessible and least safe for HIV positive women. Part of the reason for the inaccessibility and safety of abortions are due to the lack of information for the resources available. Many women who are HIV positive, who live in a country that permits abortions, do not have access to the information for a safe abortion and, thus, will opt for an unsafe and costly abortion with a lack of post-abortion care. In addition, some women may feel shameful of their diagnosis and choose to refrain from sharing their information to a large institution in fear that they will be discriminated against. In certain places, such as Zimbabwe and Thailand, HIV women who have an unwanted pregnancy do not have the option for an abortion due to the high costs, immediately limiting their choices to only having a child they may not be able to care for due to high costs of already having to care for HIV, or putting a child, who may be infected with HIV, up for adoption. Children with HIV are the least likely to be adopted because of the cost that it would entail for the adoptive parents.

On the other hand, many HIV positive women who are currently pregnant are often coerced into getting an abortion out of fear that they may transfer the infection onto their unborn child. The coercion of abortion is highly problematic because, not only does it assume that an HIV positive person cannot care for a child, it dissuades HIV positive persons from having a child because they end up believing that they are unfit to be parents.

Preventing Transmission of HIV from Parent to Child

Breast feeding is the number way to transmit HIV to a child. Many of the HIV positive children are in Sub-Sahara Africa, where the HIV rates are higher than anywhere else in the world. "Of the estimated 5.6 million people who became infected with human immunodeficiency virus (HIV) in 1999, mother-to-child-transmission (MTCT), also known as parent-to-child transmission in some circles, accounted for over a half a million HIV infections among newborns." Before 1985, parents that are HIV positive were unable to tell whether their child was HIV positive until after they were 18-months in age because the method of detection relied on antibody testing. Infants could not be confirmed to be positive or negative before 18-months because until that age, they are not creating their own antibodies. When tests for the virus itself came along, the detection of HIV could be done as early as 4-months. This was a huge stride for parents who are HIV positive. "However, these tests are not available for the vast majority of infants born to parents with HIV infection, many of whom do not have access to voluntary counselling and testing (VCT) for HIV for themselves." In 1994, there was a lot of excitement surrounding a new drug that could prevent the transmission of HIV from parent to child. Using zidovudine the risk of transmission from parent to child went from 25% to 8%, however, due to the strict regime that must be followed if using zidovudine, it was highly unlikely that the regime would be implemented in 'developing' countries, due to the lack of resources, VCT (voluntary counselling and testing) services, lack of antenatal care, etc..

Reproductive Rights

Parenthood

Many programs emphasize the importance of practicing safe sex by use of contraceptives, like the male condom, to prevent pregnancies and transmission of HIV. However, these programs often overlook the patients desire for children. Many of those who desire children are not only stigmatized by society and their community, they are also often faced with negative attitudes and biases from their healthcare provider. The presence of biases, stigma, and negative attitudes often encourage women to hide their diagnosis from their family and healthcare provider, making it more dangerous when a pregnancy does occur. In oder to reduce the transmission rate of HIV from parent to child, there needs to be a safer space for persons desiring to have children. Many HIV positive women are questioned and sometimes condemned when they have the desire to have children because people see them as willingly putting their future child in a dangerous and reckless position due to the seemingly high chances of transmission. However, there are options and ways in which HIV positive persons are able to conceive a child in a safe and controlled manner, but the stigma has cause many people to shy away from seeking the help they need and deserve to practice their reproductive rights to a child. Many HIV positive men are left in the dust when considering education about the safety precautions one must take to conceive safely. Mantell, et al., suggests that men are often unaware of how they are able to have children without transferring HIV onto their partner or onto their child. In addition, they may shy away from expressing their desire to have children.

As mentioned above, in the section about abortion, many HIV positive pregnant women are coerced into abortions, thus, dissuading them from wanting to be parents. Whether or not a person has HIV should not determine whether or not they become parents because being HIV positive does not mean one will be an inadequate parent. On the other hand, "pervasive 'pro nationalist' attitudes in Sub-Sahara Africa place pressure on women to become pregnant, regardless of HIV status. Some research suggest that for men, not having children results in stigmatization and loss of social status."

Although, rates of transmission from partner to partner is higher than desirable, there are safe options for HIV positive persons desiring children. Often times, couples that desire children only have one infected partner. For couples in which the female is infected, assisted insemination is possible. In this method, the male may masturbate and the sperm is inseminated into the infected partner, thereby bypassing infection from female to male. On the other hand, if the male partner is infected, the sperm from the male may be 'washed' and the healthy, non-infected sperm can be inseminated into the female, and again, bypassing infection.

Reproductive and Sexual Rights

The unequal treatment of HIV patients is evident in the movement called ABC -- Abstain Be Faithful and use a Condom. The movement assumes that those with HIV are suddenly uninterested in sex and should not practice their sexual freedom out of respect of those who are not infected with HIV. The assumption that those with HIV are no longer interested in sexual relations is one that does more harm than good because it creates shame for HIV positive persons who are still interested in having sexual relations. In addition, the movement appears to assume that those with HIV were unfaithful, hence why they became infected with HIV. "'Be Faithful' offers little protection to wives whose husbands have several partners or were injected before they were married. It also offers little choice to women who have no economic power and have to rely on male partners for financial support." In addition, when it comes to the matter of condoms, women usually do not have as much of a say whether their male partner wears a condom or not. Sometimes, it can be extremely difficulty and intimidating to insist that their partner wear a condom. "Women in many African countries, particularly where the patriarchal system of socialization is dominant, have neither the freedom to pursue their own sexual health nor the entitlement to meet their sexual health needs."