By Aziza Ahmed*
The International AIDS Conference in 2010 held one of the first plenary sessions dedicated to abortion and HIV. The plenary focused on the needs of HIV positive women to obtain a full range of reproductive health services, including abortion, as central to a human rights based response to the HIV epidemic.
The relationship between abortion and HIV has long been complicated by the highly politicized nature of the abortion debate. There are, however, particular reasons to pay more attention to abortion in the context of HIV. First, studies report higher rates of unintended pregnancies among HIV-positive women than other women. Second, unsafe abortion carries specific risks for HIV positive women due to increased risk of infection and hemorrhage. Third, HIV positive women may have more difficulty accessing abortions due to the double stigma not only of being HIV positive, but also being pregnant and desiring an abortion – each a stigmatizing condition in many communities. Alongside HIV specific rationales, HIV positive women require access to safe, legal abortions for the same reasons that non HIV positive women do: in order to have full access to reproductive health services that ensure a woman’s overall health and well-being. Unsafe and illegal abortions often result in death, infection, and/or long term ill-health for women. Clandestine reliance on drugs like Misoprostol can leave women in the dark with regard to safe dosage amounts and procedures – and in some cases have even led to the arrest and prosecution of women.
The presentations at the AIDS Conference made by Maria De Bruyn, Jennifer Gatsi-Mallet, Promise Mthembu, and Eugenia Lopez Uribe (in a session chaired by Sofia Gruskin) represented a geographically diverse range of experiences with unsafe abortion. The panel spoke to the need for safe abortion services from personal, medical, and policy perspectives making both a plea for increased attention to issues of unsafe and difficult access to abortion (even where legal) and for legal and policy changes to facilitate improving the health and well-being of HIV positive women.
The presentations also highlighted the ongoing activism by women’s rights groups in Mexico, Malawi, Namibia, and South Africa to demand access to a full range of non-coercive reproductive health services including safe abortion. Activists have been involved in educating HIV positive women about what constitutes a full range of reproductive health services, the differences between safe and unsafe abortion, emergency contraception, and understanding the domestic and international legal frameworks governing abortion law. In Malawi and Namibia these trainings involved participation from various individuals including representatives from family planning associations and the Ministry of Health. In addition to these trainings, women’s rights activists have been involved in direct advocacy at the national, regional, and international level to continue to demand access to safe and legal abortions despite a strong resistance. Further, women’s rights activists have pointed to the need for change within the current state of delivery of reproductive health services including trainings of doctors and nurses on safe abortion procedures, educating the community on the availability of services, sensitization of communities to safe abortion, and ensuring the availability of abortion services and post-abortion care outside of city centers.
In the context of HIV, a conversation on abortion also raises questions of coercion. Jennifer Gatsi-Mallet and Promise Mthembu, both involved in documenting and supporting litigation around the forced and coerced sterilization of HIV positive women in Namibia and South Africa, spoke to the delicate balance of offering abortion services to HIV positive women without coercing women into services. Providers must be able to make abortions available while maintaining a process of consent that allows women to make well-informed decisions. The issue of sterilization and coercive abortions, however, cannot be co-opted to support the ongoing criminalization of abortion. Instead, the existence of coercion supports the need to facilitate a woman’s supportive environment in which to make reproductive decisions.
Addressing the HIV epidemic implicates a range of reproductive health services necessary for the survival and well-being of HIV positive women. This includes ensuring access to safe abortions through decriminalizing abortion laws, greater research on the relationship between HIV and abortion, addressing the stigmas around HIV and pregnancy including abortion, and ensuring that accessible abortion services exist. The lack of access to comprehensive reproductive health services will only undermine efforts to effectively address the HIV epidemic.
*Aziza Ahmed J.D., M.S. is Assistant Professor of Law at Northeastern University School of Law.
** I would like to thank Maria De Bruyn for her help with this article (any errors are my own).