Africa: No Sex, Please - You're HIV-Positive

HIV/AIDS policies and programmes disregard the sexual needs of people living with the virus, claim a number of HIV-positive women who attended the third Africa Conference on Sexual Health and Rights -- held this week in Nigeria.

The initiatives focus on prevention and treatment, they add, ignoring the fact that people living with HIV/AIDS who are conducting normal lives still want to experience sexual pleasure, and have children.

"The epidemic has evolved. HIV-infected people are not dying; we are living and we are having sex," noted Beatrice Were, an activist in Uganda for the Global AIDS Alliance, a non-profit based in Washington.

She said health care providers and others are shocked when they discover that a person living with HIV/AIDS is either interested in or having sex, viewing this as irresponsible -- even though condoms have been shown to be highly effective in preventing transmission of the HI virus, and re-infection of a person who has already tested positive.

"We are looked upon as patients who need to be pitied, patients who must be told what to do -- and this includes to abstain from sex, and not to fall pregnant," added Were, who has been HIV-positive for 16 years. "We are treated with bias, even though we are capable of enjoying sexual pleasure without passing on the disease."

Furthermore, noted Belinda Tima -- board co-chair of the International Community of Women Living with HIV/AIDS (ICW), a charity headquartered in London -- sexual pleasure need not be limited to penetrative sex, but can take a variety of forms.

Even the staunchest advocate of condom use cannot claim that the prophylactics are completely effective, however. Is there perhaps a sense among health workers that even the small risk of someone contracting the virus during protected sex with an HIV-positive person is too great?

"Condoms are not 100 percent safe -- we refer to it as 'safer sex' -- but the risk of infection in minimal," responded Anne Ntombela, the ICW's programme director for South Africa. "If you understand the nature of HIV and how it is transmitted you will know that it is not as easy as people think. It needs exposure for a sufficient period of time under the right conditions, and it needs an exit and entry point," she added, in reference to cuts, sores and the like.

The larger issue at play is a moral one, Ntombela said. "Health care workers try to force their moral values on other people, but in reality people will not stop having sex. They would be better served if they were told how to have safer sex, rather than not to engage in sex at all."

In addition, countries should create "...an environment that supports access to services. We need prevention tools like female condoms...and we need more co-operative research on living with HIV and AIDS, and policies and programmes that take cognisance of this."

Pregnancy prevention

Concerns about the sexual activity of HIV-positive people extend to the matter of pregnancy.

HIV-positive women may pass on the virus to children during pregnancy, labour or while breastfeeding. ARVs can reduce the risk of transmission to under two percent, according to AVERT, a global charity that helps combat the pandemic. However, research has indicated persistent fears about mother-to-child transmission of HIV, and that mothers who are HIV-positive could die -- leaving behind orphans who may receive insufficient care.

"When I chose to have a baby 15 months ago people demanded to know why I took the risk of infecting my child. There was a 98 percent probability of not infecting my baby -- but people...demanded to know why I took that two percent risk," said Rolake Odetoyinbo, executive director of Positive Action for Positive Treatment, a non-governmental group in Nigeria. She has lived with HIV/AIDS for a decade.

A number of delegates at the conference claimed that certain clinics administer contraceptive injections when providing AIDS treatment to women, without receiving the consent of these women or counseling them. There are also reports of health workers acting judgmentally towards HIV-positive women in search of reproductive health care, and even denying them assistance. Indications are that women with the virus may be pressed into having an abortion where this option is available, or into being sterilised.

But even in the face of these difficulties, an array of factors prompt women living with HIV/AIDS to become pregnant or remain so, notes a 2002 report by Ipas, 'Reproductive choice and women living with HIV/AIDS'. Ipas is an international organisation for the advancement of women's sexual and reproductive rights.

It states that "...often younger women appear to be most motivated by a desire for motherhood and the idea that having a child will give them more hope. In a few cases, personal convictions that abortion is wrong may prevent them from seeking terminations, so that they end up having children 'by default'."

Social expectations as concerns family size, the stigma surrounding childlessness and unsuccessful attempts to terminate pregnancy also play a role. In addition, childbearing can be seen as "...a means of obtaining or ensuring economic support from partners".

Noted the ICW's Ntombela, diagnosed with HIV 17 years ago, "All pregnancy is risky. Telling an HIV-infected woman not to have a child is the same as telling all women not to have a child in case it is born with a defect, in case it has Down's syndrome."

"There are worse complications than HIV for a child HIV-infected children can experience a healthy life style -- it's not like 10 years ago."

Restrictive abortion laws

Another issue that came under discussion at the Third Africa Conference on Sexual Health and Rights, held Feb. 4-7 in the Nigerian capital of Abuja, was the failure of most nations on the continent to ensure legal and safe voluntary abortions.

Several speakers at the biennial meeting called for the liberalisation of abortion laws in Africa. "Annually there are 5.5 million unsafe abortions performed in Africa, resulting in 36,000 unnecessary deaths," said Elizabeth Maguire, president of Ipas.

The conference was organised by various groups, including Ipas and the World Health Organisation, under the theme 'Sexuality, Poverty and Accountability in Africa'. About 400 people from 32 countries were present at the event.