August 31, 2010
Modern medicine has made it possible for many HIV-positive women to give birth to HIV-negative babies. However, health care workers in numerous African countries, including South Africa and Namibia, have been accused of performing sterilizations on HIV-positive women without their consent, reports IRIN/PlusNews. These acts are considered serious human rights violations, and legal groups have been working with some of the women to file lawsuits.
According to the article, bilateral tubal ligations (BTLs) -- sealing the fallopian tubes shut to prevent pregnancy -- were sometimes performed on HIV-positive women without their knowledge after they gave birth. In other cases, the women were told to sign consent forms without knowing what the forms said. Some women admitted that they knew what was happening, but did not feel that they had a choice to opt out of the procedure. It has also been reported that most of these women are rural and illiterate -- and that regardless, the consent forms were presented to the women in English as opposed to their native language.
Even though it appears that some of these sterilizations occurred before vertical HIV transmission prevention services were available, many advocates believe this is an ongoing problem. The most recent sterilization reportedly took place in 2009, well after prenatal HIV interventions were implemented. From the IRIN/PlusNews article:
Local rights groups in Namibia, with the support of the International Community of Women Living with HIV/AIDS, have helped uncover 15 such cases, and a trial involving three HV-positive women who say they were sterilized at public health facilities without their consent is due to resume on 1 September in the High Court.
"It does appear that in Namibia [the practice of sterilizing HIV-positive women] has been fairly widespread and systemic," said Delme Cupido, coordinator of HIV/AIDS policy at the Open Society [Initiative for] Southern Africa (OSISA), which is providing funding for the legal action.
Similar cases have been uncovered in Zambia, and Promise [Mthembu], an AIDS and women's rights activist who was herself sterilized in 1997, is gathering stories from South African women living with HIV whose reproductive rights have been violated.
It is unknown exactly why the health care workers allegedly performed these BTLs -- perhaps trying to stop the spread of HIV, perhaps a conservative disapproval of unmarried women having children out of wedlock, perhaps mere population control. Whatever the case, most of the women involved just want an apology, not any monetary retribution. But there are barriers to that happening, according to Mushahida Adhikari, an attorney at the Women's Legal Centre in Cape Town. She told IRIN/PlusNews that "often the women have not told their families about being sterilized" and "the stigma associated with not being able to have children could be as strong as being HIV positive."
Realistically, without the cooperation of those women, getting justice will be very difficult -- as will reversing these medical procedures. In some instances, BTLs can be reversed depending on how the original procedure was done, but according to the IRIN/PlusNews article, many of these women do not have the money to undergo a second surgery.
While forced sterilizations are extreme and may not be common outside of resource-poor countries, the sentiment that HIV-positive women should not procreate is more common than one would like to admit, including among the medical community in the Western world. There has been growing research documenting this bias, including a study presented this past July at the XVIII International AIDS Conference. Researchers from Ontario found that HIV-positive women felt they were negatively judged by their doctors when expressing their desire to conceive children. In a press release, Trevor Hart, the lead author of the study, suggested that doctors need to educate themselves on the extremely low risk that a woman who is on an effective antiretroviral regimen will transmit HIV to her child. He also stressed, "There also needs to be continuing medical education to reduce the stigma perceived by HIV-positive women, which will improve their mental health and well-being."
Kellee Terrell is TheBody.com's former news editor.
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