Reproductive Choices for Women Living with HIV

1. Reproductive Choices for Women Living with HIV By Uduak Affia Africare/Nigeria

2. OVERVIEW Africare an international NGO working mainly in Africa is implementing an HIV intervention in two states of Nigeria being Lagos State and Rivers State. Funding is from PEPFAR through CDC. The Project is carrying out HIV Basic care services to people infected and affected by HIV.

3. Africare Strategies for PLP • Identifying positive cases through HCT for follow-up care services • General assessment of their needs • Provision of minimum defined standard of palliative care e.g Psychosocial support, preventive care, etc. • Home Based Care(HBC) through the use of CBOs • Referrals to other services not provided by the program such treatment and feed back mechanism to ensure utilization of services referred to.

4. Project outcome • Out of about 4,567 persons who tested positive in the project in Rivers State, about 2,502 are women of child bearing age. This calls for concern on issues bordering on Reproductive Health choices for women living with HIV

5. Reproductive Health choices Reproductive health choices has more to do with: • The right to enjoy sex • The right to have children • The right not to have children and • The right to choose which is the best method for the above while ensuring the overall health and wellbeing of the individual

6. Issues of concern • More than 80% of all women living with HIV and their partners are in their reproductive years • HIV infection may affect sexuality because of the fear of infecting ones sexual partner(s) • There has been encouraging progress in providing antiretroviral treatment for people living with HIV and AIDS. However, the continuum of care that would integrate primary and secondary prevention is still far from being implemented.

7. Issues continue • Women living with HIV have diverse reproductive health needs, and unmet need for family planning services. • HIV and family planning services have been offered separately in most settings. • How to promote condoms and dual protection and how to make them acceptable in long term-relationships remains a challenge • Male involvement in Reproductive Health programs

8. Objectives From a programmatic point of view, this paper reviews • Reasons under which women living with HIV lack access to reproductive health choices and; • Reasons for low utilization of reproductive health services in our facility

9. Approaches • Focus Group Discussions (FGDs) • Feed back mechanism of clients referred for services from Health Facilities.

10. Area of focus • Assessment of common reasons why HIV positive clients in our project don’t make positive reproductive health choices • Use of data in facilities for those referred for reproductive health services to determine program trends

11. Result / findings • There has been gross under utilization of reproductive services in our health facilities • Positive women cannot make reproductive health choices due to certain cultural, economic and other underlying factors.

12. Reasons why HIV positive women don’t make positive reproductive health choices • Lack of adequate information about condom use and other contraceptives and family planning options • Economic inequality between men and women reinforces male dominance over women in making reproductive health choices • women are often blamed for introducing HIV into their marriage and as such try to shy away from much exposure

13. Reasons cont • The unmarried women are most often blamed for infidelity. • Lack of sexual and reproductive health education among HIV positive adolescents. • Failure to disclose HIV status to Partner. • Fear of discrimination and stigmatization among HIV positive individuals. • Fear of infection by health care providers. • Lack of freedom of choice on reproductive health services needed.

14. SOLUTION HIV positive women should be empowered to take informed choices relating to their reproductive lives, free of coercion. Their specific health condition and their socio-economic situation may render them vulnerable in this regard, however, this makes support for their reproductive health rights a priority.

15. Recommendations • Reproductive health services should be provided jointly with HIV-related services. • Couple HIV Counseling and Testing should be adopted as this will • provide clear and accurate prevention messages to those seeking HCT • Mitigate tension and diffuse blame among partners • Dispel myth about HIV transmission • Create an environment that is safe for disclosure of HIV status • Create an environment for discussing family planning options

16. Recommendations cont • The existing range of contraceptive options should be available to people living with HIV, along with more information about and access to emergency contraception. • Women living with HIV who wish to use a permanent contraceptive method should have access to female sterilization in an informed manner, free of coercion.

17. Recommendation cont • Condoms use for dual protection and how to make them acceptable in long term-relationships should be promoted. • Both surgical and medical abortion are said to be safe for women living with HIV • To reduce risk of vertical transmission of HIV and in cases of infertility, people with HIV should have access to sperm washing and other assisted conception methods if available

18. Finally Support for the reproductive health rights of women with HIV is a priority and we must do all to support it

19. THANK YOU