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Women and AIDS

Jill

“Every woman should be able to decide when and whether to have children. This is true whether she is HIV-positive or not…There should be no controversy about this. None at all.” – Hillary Clinton

The International AIDS Conference this week brought NGOs, politicians and activists together to continue the fight against the global HIV/AIDS epidemic. And a key part of fighting AIDS is family planning. There’s a great op/ed here about the intersections between the two:

It is exciting to see tangible global action around these health issues, and each warrants dedicated focus with political and financial commitments. But having these two separate conferences – on two different continents within two weeks of one another – obscures an important reality: family planning and HIV are inextricably linked, especially for HIV-positive women who are pregnant or may become pregnant.

Approximately 17 million women worldwide are currently living with HIV, with more than a million new infections in women of reproductive age each year. And while addressing unmet family planning needs is essential for all women, family planning services are particularly critical for HIV-positive women who want to postpone pregnancy due to HIV-related illness, or want to access medicines and services that will allow them to give birth to an HIV-negative child.

While conferences like the ones being held in London and Washington help marshal political will and focus public attention on family planning and HIV as important global health issues, we must also ask the question: couldn’t we be accomplishing more with an integrated approach?

Many organizations like ours specialize in a particular public health area, but the women we serve have diverse needs. For example, Esnart, a 32-year-old woman in Zambia, must take a day off of work each month to access HIV treatment. She leaves before dawn traveling two hours on two different buses, just to line up to receive her medication. If she needs any other health services, such as family planning, she must join another line.

As she says, “It is not like it is integrated where you access it at the same point…When you’re done with one service, then you move on to another [line]. People get there as early as four in the morning just to queue up.”

Read it all here. And do check out this excellent infographic on the need for HIV treatment and family planning in one place.

51 thoughts on Women and AIDS

  1. It is nice to be reminded of the Secretary’s unswerving commitment to reproductive freedom.

  2. So much for the choice between her and Obama being “exactly the same, except ‘Hillary’ is a big ol’ war monger!” – The Internet, ca. 2008

  3. Meh. It’s easy to move to the liberal side after you haven’t won the presidency. See, for instance, Al Gore. I doubt she’d be saying the same thing if she were in office.

  4. 1. How does Obama not support efforts to fight AIDS? How has he not supported international family planing?

    2. How has Clinton moved to the “liberal side”? She’s always been a moderate-lefty who has spoken out about human rights / women’s rights issues.

    3. Can we actually comment on the topic of the post instead of making it a GOTCHA game of Clinton vs. Obama?

  6. Bravo to Madam Secretary.

    In a way, I’m glad that things played out the way they did, and we have her as an incredibly badass secretary of state, rather than president. It’s not to say that she couldn’t have done a good job in the white house–no doubt she could–but she would have been wasted there. Between battling with the most dysfunctional congress I’ve seen in my life and the necessary constraints of that office, we would never have seen her full talents come to fruition.

    Similarly, if she is NOT tapped as an ambassador after her time as SecState is over, whoever is at state at the time needs a head check.

  7. “Every woman should be able to decide when and whether to have children. ”

    No. Just no. If no one wants to have children with her, she should NOT be able to have children. A women should be able to choose not to have children, and if she finds someone else who wants to have children with her, and she wants to have a child with that person, and they have the ability, those two people should be able to have a child when they want, if they both agree.

  8. Given the presence of sperm banks and anonymous sperm donation, a woman can effectively decide when and whether to become pregnant, without the direct involvement of another person. But in general, Lamech, you are correct that women do not have a right to be impregnated, as that involves another individual.

  9. “Every woman should be able to decide when and whether to have children. ”

    No. Just no. If no one wants to have children with her, she should NOT be able to have children. A women should be able to choose not to have children, and if she finds someone else who wants to have children with her, and she wants to have a child with that person, and they have the ability, those two people should be able to have a child when they want, if they both agree.

    Ummm one can have a child via artificial insemination, that is a thing you know

  11. @Lamech: Yes, there are obviously many perfectly justified situations where that choice is not available. Some women can not have children for medical reasons, etc.

    It is probably supposed to be read as more of an aspirational statement that women having this choice as much as possible would be a good thing.

  12. So I was all ready to go WHOA THERE about the implied choosing to have kids while HIV+, but according to CDC as long as you get the right drugs it’s only 2% transmission rate.

    Which, I mean still. Especially if you don’t live somewhere that you can assume access to treatment in the event of transmission, buts it’s quite far away from my kneejerk “that’s just fucking reckless” reaction.

  13. So I was all ready to go WHOA THERE about the implied choosing to have kids while HIV+, but according to CDC as long as you get the right drugs it’s only 2% transmission rate.

    Yeah, I was also unaware just how low the transmission rate can be when appropriate medical care is received, so that was really cool to know (the human body = scarily amazing). Even with a higher risk, though, I still think there’s no good justification for separating these services – in all likelihood, people who are HIV+ would be having kids anyway, just with less necessary medical support for them and their children. Family planning isn’t about being the arbiter about who gets to have kids and who doesn’t – it’s about helping people have kids on their own terms.

    This article was great and Clinton’s quote is fantastic. I am trying not to think about all the vitriol it’s likely inspired in other corners of the web and social-sphere.

  14. Onymous 7.26.2012 at 1:42 pm | Permalink
    So I was all ready to go WHOA THERE about the implied choosing to have kids while HIV+, but according to CDC as long as you get the right drugs it’s only 2% transmission rate.

    Which, I mean still. Especially if you don’t live somewhere that you can assume access to treatment in the event of transmission, buts it’s quite far away from my kneejerk “that’s just fucking reckless” reaction.

    Yes, that was a major surprise for me, too. But I think the situation still presents a fair few medical ethical dilemmas. I don’t think it’s an entirely straightforward “of course she ought to!” issue.

  15. Ummm one can have a child via artificial insemination, that is a thing you know

    And if the sperm donor didn’t agree to it, then getting the semen would be sexual assault.

    1. And if the sperm donor didn’t agree to it, then getting the semen would be sexual assault.

      WTF are you even talking about? When men donate sperm for artificial insemination, they sign releases agreeing that they understand the sperm will be used to attempt to impregnate women.

      Also? This post is about HIV/AIDS and women. It is not about your personal axe you feel like grinding. Get back on topic.

  16. But I think the situation still presents a fair few medical ethical dilemmas. I don’t think it’s an entirely straightforward “of course she ought to!” issue.

    Why not? The alternative is forced contraception, forced sterilization, and forced abortions. That is horrific.

    There are a number of other conditions that are transmissable from parent to child, too: multiple sclerosis, cancer, depression. How many of those people’s rights and bodies are you prepared to restrict and interfere with?

  17. I’m with EG. Eves wereen if transmission rates were 100% it wouldn’t matter to me. Saying an HIV+ person shouldn’t give birth seems to me to be basically saying that if you’re HIV+ you would have been better off having never been born.

  18. Um, I don’t know what happened there, but that second sentence should start with “Even if transmission rates…”

  19. Lara Emily Foley, I think she is supposed to stay at home in tears because no one wants to have children with her. Unless all of the sudden someone does, and then she should be exceedingly grateful.

  20. There is a significant difference between people who contracted aids deserving to live and saying that you shouldn’t inflict aids on a child without their consent.

    Since you are the one who said you should be able to have a kid even if you were 100% going to transmit aids to them, are you seriously saying that its not okay to give someone birth control for their whole life, but its totally okay to inflict AIDs on them for their whole life?

    If there is a chance that a child could be born with a health problem, that’s entirely different than if you know 100% that you are giving them aids, presuming that you also claim that its not okay to give someone any of a group of procedures or medicines that are far less likely to detract from quality of life, in this case that would be abortifacients or birth control.

  21. No. Just no. If no one wants to have children with her, she should NOT be able to have children. A women should be able to choose not to have children, and if she finds someone else who wants to have children with her, and she wants to have a child with that person, and they have the ability, those two people should be able to have a child when they want, if they both agree.

    any reasoning behind any of this?

    your comment seems to forbid single parenthood, adoption, ivf, artificial insemination. is god/nature going to smite us unless we have good wholesome 1man/1woman families?

  22. There is a significant difference between people who contracted aids deserving to live and saying that you shouldn’t inflict aids on a child without their consent.

    love how a 2% chance of the child being HIV positive has morphed into a 100% chance of giving the kid aids…

  23. Since you are the one who said you should be able to have a kid even if you were 100% going to transmit aids to them, are you seriously saying that its not okay to give someone birth control for their whole life, but its totally okay to inflict AIDs on them for their whole life?

    It’s not like we’re infecting an otherwise healthy child with HIV. For my hypothetical 100% transmission rate, the choice is between them being born HIV+ and not being born at all. To put it another way, if it is discovered during the pregnancy that the child will be HIV+, should the parent be forced to abort?

  25. WTF are you even talking about?

    I suspect that Lamech is referring to one of the major problems that faces the world today: women saving their male partners’ used condoms instead of throwing them out, and impregnating themselves with the contents without their partners’ consent. That, and drugging their partners so that sperm can be mechanically extracted while they’re unconscious. I think there was a Law and Order episode about that once.

  26. Matt, being HIV+ is very different from having AIDS. HIV+ is manageable; not a great outlook (average 6 to 21 years less than normal lifespan), but certainly better than being born with cystic fibrosis (average lifespan 37). CF is an inheritable disease; should people with that gene not be allowed to reproduce? According to the NCBI, 1 in 29 Caucasian people in the US carry the defective gene.

  27. Saying an HIV+ person shouldn’t give birth seems to me to be basically saying that if you’re HIV+ you would have been better off having never been born.

    This seems uncomfortably close to anti-choice rhetoric, in a way; when a woman is poor and she chooses to abort for that reason, is she saying it’s better to be dead than poor? Or when she aborts because she’s single, is she saying it’s better to be dead than have a single mom? I don’t think so.

  28. Bagelsan, I see what you’re saying, and I probably should have worded my comments better. Certainly a poor woman or a single woman who aborts isn’t saying that it’s better to have never been born than to be poor or have a single mom. For that matter I don’t think that an HIV+ woman who chooses to abort is saying that it’s better to have never been born than to be HIV+. But I think any kind of blanket condemnation of HIV+ people having children implies that.

  29. Wow. You guys. Seriously. It’s a 2% transmission rate if medicines are provided, and there are a hell of a lot of people providing those medicines. My dad sometimes works under contract to a pharma company that provides free medication to literally hundreds of thousands of HIV+ women in Africa and India, and I have pretty much all the stats they provide on this, and that 2% is accurate.

    That said:

    This seems uncomfortably close to anti-choice rhetoric, in a way; when a woman is poor and she chooses to abort for that reason, is she saying it’s better to be dead than poor? Or when she aborts because she’s single, is she saying it’s better to be dead than have a single mom? I don’t think so.

    This. If someone wants to abort, they want to abort. The reasons are irrelevant. Maybe a 2% chance is too fucking high for them, maybe a bird flew over their bedroom on Wednesday and they took it as a sign their child would grow up to be a Jack Nicholson clone and they really, really hated The Shining. What the fuck does it matter?

  30. Sophia,

    Point taken. And I actually agree with you on this:

    But I think any kind of blanket condemnation of HIV+ people having children implies that.

    particularly since the transmission rate is actually lower than that of other conditions which are similarly difficult, like hemophilia, for example.

  31. @Sophia

    There’s IMO a notable difference between saying “HIV+ people shouldn’t give birth” and “if you’re HIV+ you should never have been born”. They’re both problematic by all means, but in terms of “never have been born”-judging, the former is at worst implying that people who were born with HIV should never have been born — that’s not all people with HIV.

    Certainly we should be bothered when people say “People with HIV shouldn’t reproduce”, but if we’re going to win them over (or win over people listening in), we need to engage with what they’re actually saying, not the worst-case interpretation of what they mean. So we ask if they’re worried about mother-to-fetus transmission, and if so educate them on the actual risks. If it’s because “it’s not fair for someone who’s going to die soon to have a kid because they’ll orphan it”, we educate them on the difference between HIV and AIDS, and the lifespans of people who are HIV+. If it’s a value judgement on people who aquire HIV “because they’re all druggies/sluts/poor/otherwise undesirable” or worse, then we know that it’s worse, and address that, or don’t if we think it’s a waste of time and energy.

    People in the first two categories, who are mostly just ignorant, are potential alies that we will definitely alienate if we jump on them with “that’s the same as saying anyone with HIV should never have been born!”

  32. Addendum to my comment (which is in moderation) — I realize that “educating them on the difference between HIV and AIDS” sounds like I am suggesting that thinking/arguing “people with AIDS shouldn’t be allowed to give birth” is totally fine. I guess I was to some extent, and that was wrong, so I apologize.

    All of this is complicated by the fact that people can say “X shouldn’t Y” and mean, variously:
    -X shouldn’t be permitted to Y
    – X morally shouldn’t Y (but no comment on whether they should be permitted)
    – X morally shouldn’t Y (but they should still be allowed to)
    – X pragmatically shouldn’t Y (in terms of advice, but I’m not passing moral judgement)
    – If I were X, I would consider it morally wrong to Y
    – I wish the world were such that all the X’s who Y’d could’ve been Z’s who Y’d, but since they are X’s they still have a right to have Y’d. (eg, “I wish all people born with HIV could’ve been born without it”, “I wish everyone who was born because their gestating parent was forced to carry to term could’ve been born under happier circumstances,” etc)

  33. Bagelsan, I think there’s a lot of space between saying eugenics is horrendous and being anti-choice.

  35. Hip hip hooray! An MRA has come to play! Yay!

    Tell us more about the evil spermjacking harpies, kidnapping the poor menz to steal their precious fluids.

  36. There is a significant difference between people who contracted aids deserving to live and saying that you shouldn’t inflict aids on a child without their consent.

    I “inflicted” a boatload of crappy genetics on my kid (as did his dad), without his “consent.” (How the frack would a not-yet conceived child consent to anything?). Parents inflict all kinds of things onto their non-consenting fetuses merely by conceiving them. Biology.

    I guess people with high rates of alcoholism/depression/diabetes/obesity/cleft palate just shouldn’t breed (and with each other! Double the chances of their offspring having it). Someone lock up me and my son’s father!!! We’re bad, reckless people, passing on our (eerily similar)shitty genes.

  37. I “inflicted” a boatload of crappy genetics on my kid (as did his dad), without his “consent.” (How the frack would a not-yet conceived child consent to anything?). Parents inflict all kinds of things onto their non-consenting fetuses merely by conceiving them. Biology.

    I guess people with high rates of alcoholism/depression/diabetes/obesity/cleft palate just shouldn’t breed (and with each other! Double the chances of their offspring having it). Someone lock up me and my son’s father!!! We’re bad, reckless people, passing on our (eerily similar)shitty genes.

    And for all we know, the next few decades in medical science will see revolutions in our ability to treat HIV/AIDS and other medical disorders. I mean, it may *not*, but the whole point is that we can’t really predict the future all that well. We can’t predict whether that child is going to regret being born. Plenty of people live their lives with serious debilitating medical conditions which shorten their lifespans and *don’t* regret the existence that they do have. Plenty of people are born into lives of seemingly endless privilege, support, and autonomy and do end up wishing they were dead and even taking their own lives. Assumptions about future quality of life are unbelievably shaky ground on which to base decisions regarding someone else’s current reproductive autonomy. Those decisions need to be made on the impregnated/impregnable person’s present needs and desires. Everything else is ephemeral. There are no guarantees about anyone’s hypothetical child’s future existence, for good or ill.

  38. Bagelsan, I think there’s a lot of space between saying eugenics is horrendous and being anti-choice.

    I don’t think we need to be discussing eugenics at all; I think that’s fringe hater stuff more than it’s legitimate discourse. I think that Odin kind of nailed it on how to interpret “people with AIDS should not have pass it on to kids!” which is more ignorance than flat-out hatred. It’s entirely “think of the children!!” but in a genuinely concerned way, I believe.

  39. evil spermjacking harpies

    I spermjacked a guy just the other day, though in my defense he totally left the keys in!

  40. I am surprised that no one has brought up that many HIV positive uterus-holders who intend to have children intend to do so by unprotected PIV sex. There have been many comments about HIV transmission to the resulting baby, but what about the HIV transmission to the partner?

  41. but what about the HIV transmission to the partner?

    Um, what about it? Is anybody here going to suggest that it is anything but unethical not to tell a partner about one’s HIV-status (barring things like the partner being an abusive asshole who would hurt you because of such info)?

  42. @EG
    Its not only unethical, its illegal in the states. Sentences ranges from fines to lengthy prison terms.

  43. It’s a thread about Hillary Clinton, right? And in the comment she made, she did say that there should be no controversy around when a woman has or does not have children, right? And Obama, who is our current president, doesn’t have the courage to stand up for women. At all.

    So sue me for the mean ol’ comparison. I think it’s topical. She has done more for women than all the U.S. presidents we’ve ever had.

  44. I am surprised that no one has brought up that many HIV positive uterus-holders who intend to have children intend to do so by unprotected PIV sex. There have been many comments about HIV transmission to the resulting baby, but what about the HIV transmission to the partner?

    Okay, if it has to be said, then the right to have kids while HIV+ in no way makes it okay to have unconsensual sex with anyone (unconsensual in the sense that not informing them of one’s HIV status means they are not consenting in a meaningful way because important information has been withheld). I find your statement about HIV+ people w/ uteruses intending to have them with HIV- partners (whom it seems you are implying are uninformed and unaware of their partner’s status – it should also go without saying that a person has every right to choose to have sex, protected or otherwise, with a consenting HIV+ person) pretty suspect. Can you support that claim?

  45. This is great except any number of HIV infections is simply a guess as there are many people walking around with it and refusing to get tested this includes pregnant women.

    I would not shame her but women aren’t ignorant child; if she’s HIV positive and wants a child she KNOWS she takes the risk of knowingly infecting another human being with the disease- this being her child. If she has no idea whether or not she is HIV positive and refuses to find out- she takes the same risk. If she is HIV positive and refuses treatment- same risk.

    It’s her own child she’d be infecting anyway- something she’d have to live with her on her own and couldn’t blame on another soul. I don’t think this is something anyone would take lightly.

  46. I would not shame her but women aren’t ignorant child; if she’s HIV positive and wants a child she KNOWS she takes the risk of knowingly infecting another human being with the disease- this being her child. If she has no idea whether or not she is HIV positive and refuses to find out- she takes the same risk. If she is HIV positive and refuses treatment- same risk.

    Y’all know we’re talking about women in very poor countries who have little access to treatment and medical care, right? In the U.S. and western Europe, the HIV infection rate for babies is close to zero. Almost no children are born with HIV in wealthy countries.

    In places like sub-Saharan Africa, on the other hand, many babies are born with HIV because treatment is expensive and difficult to get. Birth control is often difficult to get. Women have to get to clinics which may be miles away. Even getting tested in the first place is hard to do. A lot of women find out they’re HIV-positive while they’re giving birth. A lot of women don’t even realize they’re at risk, because they’re married and believe that the marriage is monogamous.

    I was in Cameroon last year with a UNITAID delegation addressing this exact issue. When I asked the women if they had access to birth control, they laughed. Absolutely not. Many of them found out their HIV status while they were giving birth. Many of them travel for hours to get to the clinic to get their meds (and meds to prevent transmission to their children) only to show up and there are no meds available. They face incredible social stigma for being HIV positive anyway, and not having children isn’t really seen as a socially viable option. And even if they wanted to prevent pregnancy, there isn’t a good way to do it — at least not a female-centric way, and many of their husbands aren’t going to wear condoms every time.

    So no, women aren’t ignorant children, but there are very real barriers in place.

  47. So no, women aren’t ignorant children, but there are very real barriers in place.

    http://www.icw.org/files/briefingpaper-%20motherhood%2009-08.pdf

    I knew that poor women in poor countries have a harder time, substiantially nearly impossible time. However, that does nothing to lessen the tragedy of a person born intentionally (as in not a direct result of failed contraceptive – that is including a lack of access as failed contraceptive) with HIV. It’s still a horrible thing to happen to someone- to be dying by a communicable disease at birth.

    Sometimes circumstances puts a person in a place to make a decision based on two heart wrenching choices. I’m not talking out of my ass here, I’ve risked everything with my own pregnancy gambling and it cost me my health.

    But, there are many many women right here in wealthy countries like the USA who refuse to get tested, who will skip prenatal treatment and decide that a child born with HIV is better than getting tested and taking meds or not having a child at all. These aren’t strawmen and it’s why some ob’s will not accept a patient who refuses to take an HIV test and there are people who get upset at that. I can’t fathom why giving a pregnant person and their potential baby a healthier life angers folks in the USA but it does.

    The women in subsaharan Africa have a myriad of things against them on top of povery, severe sexism, social stigma and a lack of medical treatment. They also have civil unrest and sporadic war zones. But I thought this was about women who are HIV positive who are planning to have a baby? In that case, again- I would not judge them but even in the article I linked the possibility of a poor woman in a poor county passing HIV to her child is downplayed under the guise of “support” and its bullshit. What happens when the entire family has HIV (because you can bet ART options are very expensive in poor countries) and the parents die leaving an HIV positive child to languish in an orphanage? Many of the children in orphanages in these poor countries you speak of are HIV positive and were HIV positive at birth- most are never adopted. That is the reality of that choice.

  48. Vi, I think we do not disagree, but I have presented my opinions poorly. In attempting to respond to what I thought was a silly and simplistic comment by BHuesca (which I think we feel the same way about – I completely agree with your return comments to her above as well), I over-simplified my own statement and contributed to an impression I do not actually endorse, so let me clarify:

    I do not think that HIV+ people (who are aware of their status and its implications) who have unprotected sex with HIV- people are rapists by virtue of that fact. I also understand that there are many, many reasons why an HIV+ person (or any person with a stigmatized communicable disease) would be in a position where disclosing their status would put them unduly at risk for violence and other forms of stigmatization. I also understand that HIV+ people, particularly if they are women or a member of any marginalized group, do not always have full self-determination over who they have sex with (e.g., being pressured by an abusive husband or boyfriend).

    I do not think that HIV+ people are obligated to disclose their status, including to sexual partners, when there is a reasonable risk of violence or harm against them (which I would leave up to the individual HIV+ person to determine), especially when transmission is highly unlikely (e.g., from an HIV+ cis women to an HIV- cis man through PIV intercourse). I also think that when there is no risk of violence or harm (again, leaving it up to the HIV+ individual to actually judge this) is would be a fairly sucky thing not to disclose to one’s sexual partner, because for some people any risk is too much risk. But I definitely don’t believe that HIV+ are the only people obligated to make sure that everyone has safe sex – every person is responsible for ensuring their own sexual safety to the point that they actually can, including getting tested regularly and asking their partners to get tested as well.

    That being said, I do know heterosexual women who contracted HIV from HIV+ men who specifically obsfuscated their status, and I do consider this a form of deliberate harm, though not rape specifically. It was to this latter kind of circumstance that I felt BHuesca’s original comment was simplistically referring to (because it is often the first to jump to people’s minds), so I was simplistically referring to it back. I also felt like other commenters had covered the reasons why non-disclosure might be necessary (e.g., abuse, risk of violence), so I didn’t refer to that again, which probably also made it look like I wasn’t aware of it at all. It was overall a poorly-conceived and poorly-written comment.

    Regarding the use of the word “unconsensual” specifically, I chose this word because in my research practice, consent has to be *informed* in order to be meaningful. If I were to engage a participant in a study without informing them of their risks and rights, my ethical review board would consider this to be a lack of meaningful consent, or, basically, engaging a participant without their (valid) consent. On reflection, I can see how outside of that particular headspace of mine (and I was at work while writing my earlier comment), this immediately brings up connotations of rape, which is surely an inflammatory statement and not one I intended to make. I apologize for my completely inappropriate phrasing.

    Personally, I have no interest in perpetuating stigma against HIV+ people. I have not personally ruled them out as potential sexual partners (that is not a note from my boner – I just mean I’m aware that having sex with an HIV+ person isn’t a death sentence because I am educated on the facts of sexual transmission) and advocate against their ignorant mistreatment and stigmatization. I completely agree with you that the best and safest thing we can do for everyone is educate people and destigmatize HIV+ status.

    I hope this clarifies my position.

  49. I’ve always found that using a condom does loads to alleviate any fears I have about HIV+ people sneaking into my cooch. :p

  50. @ Vi

    I posted a lengthy reply last night which went into mod at the time and maybe it’s because I’m back on my work computer, but I no longer see the reply in mod. Just in case it got sucked into the Internet ether somehow, the short version is that I expressed myself really poorly in that last comment but actually you and I agree completely, so I apologize.

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