The Reproductive Healthcare Disparities Among HIV Positive Women in Developing Countries

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Overview

HIV or human immunodeficiency virus is a chronic condition that attacks the immune system, and is commonly transmitted via bodily fluids, sexual intercourse or shared injection equipment.[1] While an estimated "20- 50% of men and women living with HIV" plan on having children, becoming pregnant may posit risks of HIV transmission to their "infants or HIV- uninfected partners" [2] While it is less common for pregnant HIV positive women living in developed countries to pass on the virus to their baby, it is still possible ,particularly, if they live in developing countries who lack STI diagnosis, reproductive technologies, or antiretroviral treatments (ART)- a triple drug antiviral therapy that is not a cure, but suppresses the virus over time and helps the individual live longer.[3] In 2018, roughly 82 percent of pregnant HIV positive women ,worldwide, had access to ART which reduced their "perinatal transmission to less than 2%".[3] In many rural areas of Africa, however, HIV treatment is limited to people who lack access to nearby health facilities and must travel far distances to receive treatment or who simply do not choose to receive treatment due to the disparities across their inequitable healthcare system. In turn, these restrictions may lead to higher HIV positive cases among their newborns. [4]Further, the profusion of impoverished women are disproportionately exposed to intersecting forms of stigma and bigotry from healthcare professionals who pre-emptively infringe upon their reproductive rights due to their callous beliefs regarding HIV. There is often a misconception that individuals who contract HIV lead sexually indiscriminate lifestyles. Thus, the social stigmas compounded with having a chronic virus could lead to shame and isolation for women in Africa's developing countries who often lack access to reproductive healthcare from contraception to abortion, and are exposed to unjust reproductive discrimination in the healthcare system.

Reproductive options

Contraception

Contraception is less common in developing countries due to the lack and low use of contraceptive products, procedures, and conflations in the individual's personal or religious beliefs. [5] In West Africa, only 8% of women (ages 15-49) use contraception compared to the 78% of women in Northern Europe.[5] However, the 70% of contraception in these countries rely on preventative methods such as female sterilizations and intrauterine devices (IUD) largely because they are cost effective compared to developed countries who rely on preventative and reversible methods.[6][5] Although the majority of HIV transmission is caused by individuals who do not use a condom during sexual intercourse, they are proven to reduce HIV transmission significantly and prevent pregnancies by 98%, however, they are not widely common in Subsaharan Africa specifically among married women, and women who use hormonal contraception.[7][8] [5]

Further, the World Health Organization(WHO) suggests that half a million expecting mothers die annually due to pregnancy complications.[5] 90 percent of these cases stem from subsaharan Africa and Asia where there is as a "unmet need for contraception provision" and an increase in HIV cases.[5] WHO's Medical Eligibility Criteria for Contraceptive Use explains that while most contraceptive methods are safe for HIV positive women, there is minimal data or studies that suggests that the majority of HIV positive women in Subsaharan Africa are using contraception to prevent unintended pregnancies.[6]

Abortion

95% of unsafe abortions occur in poorer countries, while "an estimated 4.2 million [occur] in Africa alone".[6] Terminating a pregnancy is a challenge in itself as HIV positive women are overburdened with uncertainty when deciding whether or not they want to undergo an abortion.The stress is highly cumbersome as managing a chronic condition with minimal HIV treatments could potentially elicit unpredictable implications for the mother and her baby. In addition, many women are not informed of their HIV diagnosis until later in their pregnancy which could elevate anxiety and lead to negative implications for the infant. Although abortion is illegal in many impoverished countries, the illegality does not prevent women from seeking the procedure under harmful conditions. A study conducted in Cote d’Ivoire, West Africa found that a third of pregnant HIV-positive women terminated a pregnancy despite the legal restrictions.[6]As they are managing a chronic virus while facing the hardship of reproductive limitation.

Disparities among Healthcare providers and their restrictive beliefs

As the women who live in less developed areas are often unable to make autonomous decisions regarding their reproductive health, this is due to conflicting government policies and hegemonic religious and cultural attitudes towards women's rights, specifically from healthcare providers.[5] The counselling services that is offered in many South African clinics often provide discouraging advice for HIV positive couples who intend on bearing a child, but instead violate their rights to reproductive autonomy and insensibly express a sense of control over their bodies.[9] A women who was interviewed stated that she confided in her health care provider looking for answers, but instead made her feel like she could never bear a child.[9]. Although South Africa curated a set of reproductive policies to help improve pregnancy services for HIV positive women, they are hindered by the biased beliefs of healthcare providers lack proper training in handling situations of this sort. Further, the HIV positive participants from a study reported

Access to Healthcare Services and Cost

  1. "HIV Transmission". Centres for Disease Control and Prevention. August 6, 2019. Retrieved July 21, 2020.
  2. T. Matthews, Lynn; Beyeza-Kashesya, Jolly; Cooke, Ian; Davies, Natasha; Heffron, Renee; Kaida, Angela; Kinuthia, John; Mmeje, Okeoma; E. Semprini, Augusto (2017). "Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV". AIDS and Behavior. 17 (2): 461–470. doi:10.1007/s10461-011-0068-y. line feed character in |title= at position 49 (help)
  3. 3.0 3.1 Carlsson-Lalloo, Ewa; Mellgren, Asa; Berg, Marie (18 July 2020). "Ensuring the sexual and reproductive health and rights in healthcare of women living with HIV". Sexual & reproductive healthcare: 100541. doi:10.1016/j.srhc.2020.100541.
  4. Kaida A; Laher F; Strathdee SA; Money D; Janssen PA; et al. (5 November 2010). "Contraceptive Use and Method Preference among Women in Soweto, South Africa: The Influence of Expanding Access to HIV Care and Treatment Services". PLoS ONE. 5: 1–11. doi:10.1371/journal.pone.0013868. line feed character in |title= at position 46 (help); Explicit use of et al. in: |last= (help)CS1 maint: multiple names: authors list (link)
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Mitchell, H S; Stephens, E (June 2004). "Contraception choice for HIV positive women". Sexually Transmitted Infections. British Medical Association. 80 (3): 167–173. doi:10.1136/sti.2003.008441.
  6. 6.0 6.1 6.2 6.3 Delvaux, Thérèse; Nöstlinger, Christiana (23 May 2007). "Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility". Reproductive Health Matters. 15: 46–66. doi:10.1016/S0968-8080(07)29031-7.
  7. Morrison, Charles S.; Skoler-Karpoff, Stephanie; Kwok, Cynthia; Chen, Pai-Lien; van de Wijgert, Janneke; Gehret-Plagianos, Marlena; Patel, Smruti; Ahmed, Khatija; Ramjee, Gita (20 Feb 2012). "Hormonal contraception and the risk of HIV acquisition among women in South Africa". AIDS (London). 26: 497–504. doi:10.1097/qad.0b013e32834fa13d. line feed character in |title= at position 43 (help)
  8. Heikinheimo, Oskari; Lahteenmaki, Pekka (1 November 2008). "Contraception and HIV infection in women". Human Reproduction Update. 15: 165–176. doi:10.1093/humupd/dmn049. line feed character in |title= at position 35 (help)
  9. 9.0 9.1 London, Leslie; J. Orner, Phyllis; Myer, Landon (2008). "'EVEN IF YOU'RE POSITIVE, YOU STILL HAVE RIGHTS BECAUSE YOU ARE A PERSON': HUMAN RIGHTS AND THE REPRODUCTIVE CHOICE OF HIV-POSITIVE PERSONS". Developing World Bioethics. 8 (1): 11–22. doi:10.1111/j.1471-8847.2007.00223.x. line feed character in |title= at position 60 (help)