Since the 2006 Toronto International AIDS Conference, an increasing number of organizations have spoken
out about the need to respect the reproductive rights of women living
with HIV/AIDS. In many instances, however, the focus has been primarily
on three issues: access of HIV-positive women to modern contraceptive
methods, condemnation of forced sterilization and coerced abortions,
and HIV-positive women’s right to bear children safely through measures
to prevent perinatal transmission.

A
topic that is often neglected – or avoided – has been enabling HIV-positive
women to deal with unwanted pregnancies through emergency contraception
and voluntary safe legal abortion. So how was the topic covered at the
Mexico AIDS conference? A quick scan of the conference program (which
may admittedly have omitted some references) shows that of the 7309
abstracts on the conference CD-ROM, about 50 addressed pregnancy termination
in some way.

About
21 abstracts reported on abortion rates in relation to pregnancy outcomes
– a large proportion of these studies referred to sex workers, with
only a few focused on women living with HIV. One abstract mentioned
stigmatization of HIV being increased due to its association with pollution
and abortion in South Africa; a few also mentioned forced abortion as
a human rights violation.

A
handful of research reports incorporated abortion as a study topic.
Barbosa et al. compared access of HIV-positive and HIV-negative women
to abortion services in Brazil. They found that women living with HIV
more often had abortions (and tubal ligations) but they did not present
information on why this might be the case. The Women’s Health Research
Unit from the University of Cape Town, South Africa, reported on interview
studies with people living with HIV and health-care providers, concluding
that "tailored contraception, preconception, and termination of pregnancy
counselling may be critical to helping HIV+ women and men…make informed
decisions that optimize the reproductive health outcomes for them as
well as their future children." Nevertheless, Ruth Borms reported
that even in Europe, where abortion is permitted by law, health-care
providers seldom discuss pregnancy termination with HIV-positive clients.

While
voluntary pregnancy termination was scarcely addressed at previous AIDS
conferences as a policy issue, several speakers addressed the need to
include abortion care within the scope of reproductive rights. Notable
examples: Morolake Odetoyinbo (GNP+, Nigeria) stated that prevention
of unsafe abortion, treatment of miscarriages and postabortion care
are special needs of HIV-positive women. Shaun Mellors (International
HIV/AIDS Alliance), Marion Stevens (Health Systems Trust, South Africa),
Kalindy Bolivar (Coordinadora
Juvenil por la Equidad de Género, Ecuador),
and Elizabeth Maguire (Ipas) reflected on the need to include both safe
motherhood and safe pregnancy termination as services for women living
with HIV. Zonny Woods, who spoke in the closing plenary on the needs
of women and girls, also mentioned the need to include safe abortion
as a reproductive right for HIV-positive women.

These
presentations were encouraging steps forward, but much remains to be
done to overcome the stigma and taboos attached to the issue. I was
able to attend a couple panels on integration of HIV/AIDS and reproductive
health services; what was striking about some of those presentations
was that abortion was presented as an obstacle and a problem to be overcome
in promoting linkages and integration, not as a right that women living
with HIV should have so that they can deal with unwanted pregnancies.

Ipas
and the Health Systems Trust offered a Global Village session on "Linking
HIV and reproductive choice – reflecting on strategies for advocacy,"
the first time that pregnancy termination was a workshop topic. We started
off with 24 participants but when it became clear that we would talk
specifically about abortion care, many people left. Debbie Billings
remarked: "Unwanted pregnancy among positive women is a reality that
hardly is discussed. The workshop that I attended was one of the few
spaces in the conference where abortion as an option was addressed. It
was disappointing to see so many participants leave the workshop just
as we broke into small groups to strategize how to disseminate messages
about positive women’s reproductive rights. The topic of abortion seemed
to make many people uncomfortable, so much so that they had to leave
the session." 

Our
advocacy for the rights of women living with HIV to become mothers has
definitely advanced in recent years – we are talking about their right
to bear children, to use assisted conception and to adopt children.
Hopefully, the right of HIV-positive women to avoid unwanted pregnancies
will become as accepted an issue at the next AIDS conference in 2010,
not only in presentations on policy needs but also sessions discussing
interventions and linkages between HIV/AIDS and reproductive health
services.