Fourteen years ago, Edilia Natera learned she was HIV-positive when her doctor ran blood tests during her pregnancy. What would be devastating news to any expecting mother was tantamount to a death sentence for Edilia.

“There wasn’t the same knowledge [in the Dominican Republic] in those days as there is now,” Natera remembers. “I didn’t have help.”

During childbirth, Natera’s baby came in contact with her blood and was born HIV-positive. “Now, if you’re pregnant, treatment starts right away. Doctors perform a Cesarean and you don’t breastfeed. If you follow all the instructions the doctor gives you, your baby may be born healthy. Mine wasn’t so lucky.” Natera’s baby died when she was just five years old.

While awareness of HIV/AIDS has increased in the Dominican Republic in recent years, tackling the disease remains a daunting challenge. A UN-funded report released this week, “Gender Equality and HIV in the Dominican Republic,” reveals that sixty percent of the people living with HIV in the Dominican Republic are women. It is one of the countries with the highest prevalence of HIV in the Caribbean, and HIV is now the leading cause of death among women of reproductive age.

Stepping up to the challenges and making progress PROFAMILIA-Dominican Republic, a Member Association of International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), knows these statistics all too well. To stem the epidemic, PROFAMILIA has integrated HIV/AIDS prevention, treatment and testing into its extensive clinical sexual and reproductive health (SRH) services. PROFAMILIA’s comprehensive HIV/AIDS care includes education and condom promotion, testing, psycho-social support and counseling.

In 2004, PROFAMILIA became IPPF/WHR’s first Member Association in Latin America and the Caribbean to offer treatment to people living with HIV/AIDS. Through a partnership with CORPRESIDA, the national body for HIV/AIDS, anti- retroviral medication is available free- of-charge to all HIV-positive patients in three PROFAMILIA clinics.

There are two key elements to PROFAMILIA’s integrated approach: a focus on a broad range of vulnerable groups—from youth to women and immigrant populations—and a staunch commitment to fighting the stigma, discrimination and gender- based violence often associated with an HIV-positive status.

Leona Adolfo has worked for three years as a nurse for PROFAMILIA’s mobile unit serving the Abacao Batey, an impoverished, mostly Haitian-descendant community that worked for the sugar refineries. More than 400 people live in Abacao, mostly in wooden shacks without latrines. “Many people who live in the bateyes don’t have papers to visit the hospitals,” explains Adolfo, whose father was a Haitian contractor. “There are women who are 18 years old and they have three kids. They don’t go to school; they don’t have a job. There are many cases of teenage pregnancy and violence.”

Through the health services and education Adolfo provides, she has noticed real change in Abacao. “If this project did not exist, there would be more women with cancer, more pregnant teenagers, more people with HIV.” Most personally gratifying for Adolfo is giving people with so little, a chance to receive SRH services for free in one of PROFAMILIA’s clinics, where there’s no discrimination. “White, poor, rich, Dominican, Haitian, Haitian- Dominican, we are all human beings. [At PROFAMILIA,] everyone is treated in the same way.”

Despite this progress, more effort is needed to end discrimination and stigma within the wider Dominican society. According to a 2009 study by PROFAMILIA on HIV stigma and discrimination, HIV-positive men, and even more so, women have a lower level of education, significantly higher levels of unemployment and a greater degree of poverty—the annual income for some 71 percent of study participants was $3,000 US dollars or less.

In addition, HIV-positive people are disproportionally subject to discrimination, including verbal assault and physical abuse. HIV-positive women fare even worse: 53 percent of HIV- positive women, or twice the national average, had endured violence, ranging from physical abuse to being forced to have sex.

Natera, who now works as an HIV counselor at PROFAMILIA’s Santo Domingo clinic, draws on her own experiences with discrimination when educating her clients about gender- based violence and living with HIV. “I help the person see that, even if they have been diagnosed with HIV, it’s not the end of the world. They can continue living.” She has been repaid continually with stories from her community that reflect great strength and renewal. “People have come here so debilitated and they have found strength. That’s powerful.”