Luisa Cabal

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Linking reproductive health services and HIV
interventions human rights considerations

• Luisa Cabal
• Center for Reproductive Rights

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I learned that they had sterilized me at the
time of the cesarean when I awoke from anesthesia
a few hours later. I was in the recovery room at
the Curicó Hospital when the nurse entered and,
after asking me how I was feeling, told me that I
was sterilized and that I would not be able to
have any more children They treated me like I
was less than a person. It was not my decision to
end my fertility they took it away from me.
F.S.
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Human Rights Framework
Framework Reproductive rights stem from the
right of all couples and individuals to decide
freely and responsibly the number, spacing and
timing of their children, and to have the
information and means to do so free from
discrimination, coercion, and violence. (ICPD
1994, Beijing 1995)   This basic right rests on a
host of human rights that are recognized in
national laws and binding international and
regional human rights agreements.

• Importance of linking SRH and HIV is widely
  recognized
• Challenge create a generalized understanding
  that human rights need to be respected and
  protected in providing services. WHY?

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• What happens when HIV-positive women access
  reproductive health services?
• Research shows that in spite of these legal
  standards, pervasive stigma around HIV-positive
  people exercising reproductive rights leads to
  discriminatory treatment that infringes womens
  rights to
• Make free and informed decisions to become
  pregnant or to prevent pregnancy
• Receive acceptable, quality prenatal, delivery,
  and postnatal care
• Access information and services on
  contraception, safe legal abortion and/or
  post-abortion care and
• Make informed decisions around their continued
  fertility and future pregnancies.

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What happens on the ground

• Documentation in Latin America (and other parts
  of the world) on stigma and discrimination at the
  intersection of SRH and HIV
• Discouraged from becoming pregnant or given
  misinformation about HIV and pregnancy
• Denied information on contraception or on how to
  conceive safely (e.g., sero-discordant couples)
• Mandatory HIV screening and/or testing without
  informed consent
• Lack of confidentiality
• Inadequate PMTCT and post-partum counseling
• Delays or denial of treatment
• Verbal abuse
• Coercive or forced sterilization

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Repercussions of Discrimination and Coercion in
Health Care Settings

• Discrimination and coercion in the healthcare
  setting carries significant public health
  consequences, and undermine prevention and
  treatment efforts. For example
• Discourages testing or returning for test
  results.
• Deters institutional births, undermining PMTCT
  programs.
• Interferes with adherence to treatment programs
  and can otherwise deter individuals from seeking
  necessary treatment and care.
• Perpetuates self-stigmatization and a sense of
  shame and worthlessness for PLHIV.

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Case study Coercive and Forced Sterilizations of
HIV-Positive Women

• Coercive and forced sterilizations have long been
  used to control the fertility of marginalized
  populations. Over the past decade, cases of
  involuntary sterilizations of HIV-positive women
  have emerged as a growing concern and one that
  lacks geographical boundaries.
• Women and HIV in Chile
• One of the richest countries in the region
• Low HIV prevalence rate (.3)
• Universal access to ART
• Laws prohibit discrimination against PLHIV in
  health care
• Women make up 28 of PLHIV in Chile

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F.S. v. Chile A Case Study

•  But widespread coercion around motherhood and
  HIV
• 56 women surveyed were pressured by health
  workers to prevent pregnancy
• 29 underwent surgical sterilization under
  pressure from healthcare providers
• 12.9 were sterilized without their consent (Vivo
  Positivo, 2004)
• In 2002, F.S. learned she was HIV-positive
  during routine prenatal testing. She did not
  receive any counseling on what she was testing
  for or what a positive result might mean.
• She took all precautions throughout her pregnancy
  to minimize the risk of MTCT. She underwent a
  cesarean operation, giving birth to a healthy,
  HIV-negative boy.

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F.S. v. Chile A Case Study
When she awoke from the anesthesia several hours
later she learned that she would not have any
more childrenthe surgeon had sterilized her
without her knowledge or consent during the
surgery. F.S. did not know that the doctors
actions violated Chilean law. Vivo Positivo, a
Chilean advocacy organization, helped empower
F.S. to claim her rights and to take action to
hold the doctor who sterilized her accountable.
F.S. wanted to ensure that other women did not
have to experience the trauma of forced
sterilization. In 2007, after many failed
attempts to get legal representation, F.S. filed
a criminal complaint against the surgeon who had
sterilized her, but the investigation and trial
were marked by bias and irregularities and in
August 2008, the case was dismissed. In February
2009, the Center for Reproductive Rights and Vivo
Positivo presented F.S.s case to the
Inter-American Commission on Human Rights.  
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Prevent, Address, Redress

• Higher GDP and greater access to ARV does not
  prevent violations from happening in the context
  of access to reproductive health services for
  people living with HIV.
• The importance of the legal and policy framework
  symbolic and the real consequences it can have
  (what happens when a court sends a message that
  PLWHA should not marry/law goes to the extreme of
  making a pregnant woman a criminal if she
  transmits HIV to her child)
• Law is not enough need to address the
  implementation gap address role of health sector
  in ensuring access to services that are
  protective of human rights. A core priority
  needs to be to reduce stigma and discrimination
  from health care professionals by implementing
  and intensifying training programs
• Who will be the eyes and ears on the ground?
  Importance of accountability from the community
  and health-care setting level to
  institutionalized forms (human rights
  institutions, judicial bodies)

 
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Thank youwww.reproductiverights.org