“Although the sexual and reproductive health-related rights, needs and aspirations of HIV positive women and men are very similar to those of men and women not infected with HIV, some key biological and social differences require specific attention.” (Gruskin, Ferguson, O'Malley)
In 2006, there were some 39.7 million people living with HIV, half of them under the age of 25.Footnote* People living with HIV have sexual and reproductive health needs and concerns, some of which are related to having HIV and others which they have in common with their non-infected peers. Yet sexual and reproductive health policies, programmes and services often fail to take into consideration the needs and wishes of people living with HIV. Most programmes currently revolve around voluntary testing and counselling for HIV, access to antiretroviral and other AIDS-related treatment, and hospital and home-based care for those with HIV- and AIDS-related illnesses. In relation to sexual and reproductive health care, HIV prevention predominates. There are condom social marketing and other safer sex promotion programmes and recent initiatives to promote family planning for people with HIV. Prevention of mother-to-child transmission of HIV in antenatal and delivery care has also begun to get greater programmatic attention and support. Management of sexually transmitted infections often sits uncomfortably in the middle. However, health services rarely deal with the full range of sexual and reproductive health needs of people living with HIV.
“Health care providers, some of whom may themselves be HIV positive, can make an important difference, especially if they are supported in their working conditions, are knowledgeable about HIV and sexual and reproductive health and have the skills to provide good quality care.” (Bharat and Mahendra)
In March 2006, a global consultation on the rights of people living with HIV to sexual and reproductive health was held in Addis Ababa, Ethiopia. It was co-convened by the United Nations Population Fund (UNFPA), the World Health Organization (WHO) and EngenderHealth, in collaboration with the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV (ICW), the International Planned Parenthood Federation (IPPF) and Young Positives. The main objective of the consultation was to identify key issues related to policies and programmes that can support the sexual and reproductive health and human rights of people living with HIV.Footnote†
This consultation was a landmark initiative, bringing together policymakers, programme managers, donors, non-governmental organisations, researchers and international, regional and national networks of people living with HIV. The dialogue that was initiated was an important step towards recognising the rights related to the sexual and reproductive health of people living with HIV and the ways in which those rights can be respected, protected and fulfilled. Participants from the networks of people living with HIV and AIDS proposed convening a global meeting of positive people's networks to discuss their sexual and reproductive health and related human rights, which is currently being prepared. The consultation also agreed that comprehensive guidance on the sexual and reproductive health and related human rights of people living with HIV should be developed, covering advocacy, health systems and broader policy dimensions. Finally the Addis consultation recommended that the background papers should be published and made widely available. The papers in this volume – six of the background papers prepared for the consultation – were commissioned by the World Health Organization's Department of Reproductive Health and Research, with funding from the William and Flora Hewlett Foundation.
Reproductive Health Matters has been publishing information on the linkages between sexual and reproductive health and rights and HIV for 15 years, and is pleased to be able to publish these papers as a journal supplement.
The papers
The papers review what is known about the specific sexual and reproductive health needs of people living with HIV, and the challenges of providing appropriate services from legal, policy and health systems perspectives. The first paper contains an overview of key human rights, policy and health systems issues, and provides an overarching framework for the other papers. Three papers focus on specific aspects of sexual and reproductive health: parenthood; contraception, abortion and fertility; and sexual
Receiving an HIV positive test result, Rwanda, 2005
“Availability of contraceptive services, better access to assisted conception services and termination of unwanted pregnancy, carried out with respect for the reproductive rights of all individuals, constitutes a great challenge… if services are to meet the fertility-related needs of men, women and couples living with HIV.” (Delvaux and Nöstlinger)
The papers address the rights and needs of both HIV positive women and men, their partners, children and families. Many people living with HIV are in sero-discordant relationships, that is, one is HIV positive and the other is not. Others are in relationships where both partners are positive. In some cases, these relationships are long-term and monogamous. In others, there may be more than one partner or partner change. This implies diverse needs that are not always recognised, not only in relation to the practice of safer sex but also fertility, family planning, and parenting.
“Sexual health is defined in terms of well-being, but is challenged by the social, cultural and economic realities faced by women and men with HIV.” (Shapiro and Ray)
The authors use human rights considerations as a basis for analysis and include recommendations on the kinds of health services that should (but may or may not) be available to people living with HIV in different regions. All the papers have incorporated the perspectives of people living with HIV and highlight some of the particular needs of HIV positive young people.
“… studies suggest that the rights of people with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions.” (Segurado and Paiva)
Ensuring the universal provision of appropriate sexual and reproductive health services is an enormous challenge. The HIV pandemic is a very long way from receding – indeed, for every person who knows their HIV status there are nine more who do not or who prefer not to know. Recognition of the sexual and reproductive health needs and rights of people living with HIV is an essential step towards strengthening and expanding appropriate services so that people living with HIV are better able to seek and obtain the health care and support they need.
“HIV positive women and men have the right to healthy sexual and reproductive lives. Health services that provide non-coercive, non-judgemental support and services for HIV positive women and men can help them to make informed decisions about sex and reproduction. With political and community-wide commitment to the human rights of HIV positive women and men, as well as positive people's meaningful involvement in policy and programme design, truly transformative change can take place.” (Bell, Mthembu, O'Sullivan and Moody)
Notes
* Report on the Global AIDS Epidemic. Geneva: UNAIDS, 2006.
† Meeting Report of the Global Consultation on the Rights of People Living with HIV to Sexual and Reproductive Health, March 2006. At: <www.who.int/reproductive-health/hiv/final_global_consultation.pdf>.
Related Research Data
