Saturday, March 10, 2012

National Women and Girls HIV/AIDS Awareness Day

(Our thanks to IntLawGrrls for the opportunity to contribute and to The Women’s Collective and the International Community of Women Living with HIV/AIDS for the fellowship experiences that have informed this post)
In the U.S., today is National Women and Girls HIV/AIDS Awareness Day (NWGHAAD), when we are encouraged to take action in the fight against HIV/AIDS and raise awareness of its impact on women and girls. Two protections that remain critical to safeguarding the rights of HIV positive women and girls are: 1) Equal access to healthcare, and 2) Sexual and reproductive health rights (SRHR). NWGHAAD creates an opportune moment to consider how the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the preeminent women’s rights treaty signed by the U.S. and 98 other states parties, is serving these needs of women and girls living with HIV around the world.
States parties to CEDAW commit to undertake measures to end all forms of discrimination against women. CEDAW provides the basis for realizing equality between women and men by ensuring women’s equal access to and opportunities in, political and public life, including health and reproductive rights. In particular, in Article 2(a), states parties commit to undertake to
embody the principle of the equality of men and women in their national constitutions or other appropriate legislation if not yet incorporated therein and to ensure, through law and other appropriate means, the practical realization of this principle.
CEDAW and Equal Access to Healthcare Services for Women Living with HIV
CEDAW can be called on to ensure women and girls’ equal access to HIV services. For example, Article 10 guarantees equal access to “specific educational information to help ensure the health and well-being of families, including information and advice on family planning.” Article 12 also mandates states parties to “take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality […] access to health care services, including those related to family planning.” Article 14 pays special attention to the needs of rural women, demanding that states parties ensure equality of rural men and women in accessing “adequate health care facilities, including information, counselling and services in family planning.”

CEDAW and Sexual and Reproductive Health Rights of Women Living with HIV
CEDAW devotes special attention to the SRHR of women, including women living with HIV. Article 11 requires states parties to take appropriate measures to “prohibit, subject to the imposition of sanctions, dismissal on the grounds of pregnancy or of maternity leave and discrimination in dismissals on the basis of marital status.” Article 12 requires states parties to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.” Article 16 also protects the rights of women, including those living with HIV, to decide the number and spacing of their children and to have “access to the information, education and means” necessary to allow them to exercise these rights.

The Reality of CEDAW for Women and Girls Living with HIV
Unfortunately, CEDAW’s many protections remain elusive for women and girls living with HIV as they experience frequent and systematic denials of their right to equally access healthcare, including sexual and reproductive health services. What’s worse, the stigma attached to HIV discourages many women from even attempting to enforce CEDAW’s protections because such an attempt would require women to disclose their HIV status and thereby risk stigmatization.
Due to social and structural injustices, socioeconomic challenges, cultural taboos and myriad other factors, HIV positive women face particular difficulty accessing healthcare services. For some women, gender-based violence manifests itself as both a cause of HIV infection, through sexual violence, and also as a preventive factor in healthcare access. For example, consider a woman whose partner threatens abuse if she attempts to access care because the woman’s access to HIV treatment may imply that her partner is also HIV positive.
Poverty, when unaddressed, also has far-reaching impact on women living with HIV. The CEDAW preamble itself recognizes that in situations of poverty, women experience the least access to health. For women and girls living with HIV, poverty is even more destabilizing- as these women and girls’ financial need to care for themselves rise, their earning capacities are driven downward by discriminatory employment practices, other forms of stigmatization, and disabling opportunistic infections. As a result, the already devastating impact of poverty on women worsens exponentially for HIV positive women.
Moreover, women sometimes self-select out of healthcare services. As primary caregivers, it is not uncommon for women to prioritize the needs of their families above their own. As a result, HIV positive women frequently forego medical care, choosing instead to feed, clothe and care for their families.
With regard to SRHR, a number of factors obstruct HIV positive women’s access to CEDAW’s protections. In a recently published paper, The Women’s Collective (TWC), found that HIV positive women in the District of Columbia face substantial barriers as they attempt to access sexual and reproductive health services. The moral judgment of treating physicians and the broader healthcare field is particularly troubling. One HIV positive woman believed that healthcare providers often dub HIV positive women as irresponsible for considering childbearing, despite women’s right to plan the number and spacing of their children as well as data showing that the risk of transmitting HIV during childbirth can be reduced to less than 2% with proper care.
Even some global health institutions have contributed to the denial of the right to information and right to informed consent, contributing to unequal health outcomes. The World Health Organization (WHO) recently held a technical consultation regarding the impact of hormonal contraceptives on HIV acquisition, transmission, and progression risks. Meeting participants concluded that although current data are inconclusive, a clarification is needed because some data have suggested that use of injectable hormonal contraceptives, commonly used in poor urban settings in the U.S. and many parts of Africa, has increased HIV transmission risk. Despite the WHO’s recognition of this potential risk, providers and consumers have been told that all hormonal contraceptives are “safe.” Providers who rely on the WHO’s assertion of safety and thereby fail to clarify the potential risk of transmission for their patients will deny women’s right to information and informed consent when prescribing such contraception. International Community of Women Living with HIV/AIDS Eastern Africa (ICWEA) Regional Coordinator Lillian Mworeko, who participated in the WHO meeting, emphasized, “Our healthcare providers must properly inform us of the potential heightened HIV risks of using injectable hormonal contraception. It is our right to weigh these risks and benefits and decide for ourselves whether or not to accept such contraceptives.”
It is clear that CEDAW’s provisions remain inviting, but unfulfilled so long as states parties fail to use laws and appropriate means to practically realize gender equality for women and girls living with HIV. On this NWGHAAD, we hope to first, honor the many women and girls who have struggled and continue to struggle with HIV/AIDS and second, remind the international community of its legal obligations to these women and girls.

1 comment:

Wendy Lyon said...

Let it not be forgotten that many women and girls are put at risk of HIV/AIDS through laws that criminalise selling sex or related activities. Such laws expose sex workers to riskier sexual practices, impede their access to educational, preventive and treatment services and increase the stigma against them which only reinforces the risks. CEDAW's protections must not exclude this particularly vulnerable group of women - or worse, Article 6 must not be used as justification for policies which increase their vulnerability to HIV/AIDS.