Abstract

Universal access to reproductive health for women with HIV? Policy and programme gaps in Latin America

T.R. Kendall¹, E. López Uribe², G. García Patiño<sup>2

1</sup>University of British Columbia, Community, Culture & Global Studies, Kelowna, Canada, ²Balance, Promoción para el Desarrollo y Juventud, Mexico City, Mexico

Background: Inclusion of “universal access to reproductive health” as a Millennium Development Goal affirms the importance of reproductive rights for sustainable development and gender equity. Integration of sexual and reproductive health services and HIV?offering HIV testing in family planning and STI clinics and meeting sexual and reproductive health needs in HIV care-- has been recognized as a crucial component of a comprehensive HIV strategy since the Glion Consensus of 2004.
Methods: Comparative content analysis of National HIV Action Plans, HIV legislation, and relevant technical guidelines of 8 Latin American countries: Bolivia, Colombia, Guatemala, Honduras, Mexico, Nicaragua, Paraguay and Peru. In-depth interviews with HIV decision-makers, healthcare providers and civil society (n=48) explored on the ground realities.
Results: Half of the national HIV plans mention the sexual and reproductive health of people with HIV, however concrete actions such as screening for the human papilloma virus, treating cervical cancer, diagnosing and treating other STIs (other than syphilis), and access to assisted reproduction are wholly absent. Only Nicaragua mentions contraceptive coverage as an indicator for evaluating the quality of HIV services. Mexico includes social marketing of female and male condoms in the national plan but female condoms (FC) are not available in HIV clinics and the second generation FC cannot be imported; no other country mentions the female condom as part of the HIV strategy. Stigmatizing attitudes towards positive women's right to bear children, instances of coerced abortion and sterilization, and failure to respond to family planning beyond the promotion of the male condom, characterize reproductive health care for women with HIV in the region.
Conclusions: The reproductive and sexual rights and health of women with HIV remain invisible in policy and programming of the eight countries analyzed. Policymakers and HIV and reproductive healthcare providers are missing key opportunities to guarantee universal access to reproductive health.