One of the major focus areas of the XVIII International AIDS Conference
in Vienna is on the growing HIV epidemic in Eastern Europe and Central Asia and how harm reduction strategies can help prevent HIV transmission. HIV in these regions is concentrated in the most at-risk populations, including intravenous drug users, sex workers, and men who have sex with men.
Harm reduction strategies have been found to be an effective way to prevent HIV transmission as well as reduce risky behaviors. But what exactly does harm reduction mean? Harm reduction is making potentially risky behaviors or situations safer, instead of stigmatizing those behaviors or making them illegal, which is a goal of the Vienna Declaration
and a subject here in Vienna. Providing at-risk populations the information and tools they need significantly reduces their own risk of infection and transmission.
The discussion of reforming drug policies seems disjointed from the topic of integrating HIV/AIDS and sexual and reproductive health services, but there are some underlying similarities. People living with HIV/AIDS (PLWHA ) have the right to engage in consensual sexual activity, enjoy their sexuality, and have children if they choose, but communities and even health providers often stigmatize these behaviors. Although engaging in sexual activity and having children while HIV positive does carry risk, these risks can be significantly reduced with appropriate information, protection, and treatment.
In a session, titled “Improving access to pregnancy planning and reproductive options for people living with HIV through evidence-based policy development and advocacy,” experts discussed the issue of protecting the reproductive rights of PLWHA and how provider stigma prevents women and couples from getting the care they need which often results in riskier situations.
Gloria Careaga from Mexico spoke about how HIV-positive women in her country are condemned and considered asexual by the community and by many health providers. Ulrike Sonnenberg-Schwan of Germany also noted an example of a German doctor telling a positive concordant couple who wanted to get pregnant that their chance of having an HIV-positive baby was very high; he said that because the mother was positive, the baby had a 25% chance of being born positive, and because the father was also positive, the baby had an additional 25% chance of being born positive, for a total of 50% chance of infection. In reality, the likelihood of transmission of HIV to the baby when the mother has access to ART and comprehensive healthcare is very low.
Research conducted by Dawn Averitt-Bridge found that half of HIV-positive women who had a pregnancy or would consider having children in the future have never been asked by a provider if they would like to have children. A significant percentage of HIV-positive women who were or had been pregnant while infected were not aware of HIV treatment options when they became pregnant. These examples demonstrate the prevalence of stigma against women with HIV and inattention to their rights and desires, even among providers in developed countries. These biases can be a significant barrier to full integration of services and providing comprehensive care for women with HIV.
When care providers are aware of treatment and prevention options for PLWHA and openly share this information with their patients, PLWHA can reduce the risk of vertical and horizontal transmission, while maintaining their rights. On the other hand, if the community and care providers criticize and stigmatize PLWHA for wanting to have sex and plan their families, the opportunity for harm reduction is lost.
How have you addressed provider stigma against the sexuality of PLWHA in your community?
K4Health will be blogging during the XVIII International AIDS Conference.