Dreams and Desires

1
Dreams and Desires

• Exploring the sexual and reproductive choices of
  HIV positive men and women

Kevin Osborne, Senior HIV Advisor, IPPF
2
Background

• SRH needs and choices of PLHIV a neglected area
• Recently gaining attention
• Confusion how to implement?
• Hearing the voices of people living with HIV

3

• Collaborations with GNP and ICW
• Qualitative research into the experiences of HIV
  people
• Positive women seeking SRH services
• Positive men who wish to become fathers

4
4 Key Factors

• Fertility choices
• Policy gaps and challenges
• Stigma and discrimination
• Status and disclosure

5
Tatiana, Belarus

• Several months ago I made the decision to
  have another child. I wanted this very much and
  so did my current partner. When I spoke to my
  gynaecologist about our desire to have a child
  she put up many barriers and displayed a very
  negative attitude towards our plans. This was
  extremely distressing for me, but I went ahead
  with the pregnancy nonetheless. Sadly, the
  pregnancy was not successful this time around,
  but not because of HIV. The gynaecologist was
  visibly relieved to no longer be dealing with my
  pregnancy.

6
1. Fertility Choices

• Increase in decisions to be made around
  reproductive health and parenting
• Constraints on access to services and information
• Health worker attitudes
• Dual protection and interactions with ARVs

7
Rosa, Honduras

• The prevailing social and political attitudes
  in this region run contrary to the desires of
  many positive women. The idea persists that
  people living with HIV must not engage in sex or
  have children.

8
2. Policy gaps and challenges

• Traditional prevention efforts have not reached
  PLHIV
• Criminalization laws and policies are an
  impediment
• GIPA is still too tokenistic
• PLHIV are often agents of change

9
Aruna, Sri Lanka

• Being a positive father is not easy. I see
  my son for fifteen minutes once a week. I have
  only picked him up and hugged him maybe two or
  three times in seven years, because his mother is
  afraid that he will become infected. Her family
  tells my son not to touch me because of HIV. For
  me, knowing my status changed how I am with my
  son, I cant touch him or hug him like any
  ordinary father can anymore. I have to love him
  from a distance.

10
3. Stigma and Discrimination

• Rejection by sexual partners
• Self stigma
• Health worker attitudes and biases

11
Scott, USA

• Choosing the right time to disclose to my
  son was one of the most difficult decisions I had
  to make as a single parent. I was afraid he would
  tell his mom and that she would drag me back to
  court. I was afraid if I told his friends he
  would be ridiculed on a day to day basis. I was
  worried that the knowledge of his dad living with
  HIV would create an unbelievable amount of
  additional stress and worry for him.

12
Status and Disclosure

• Disclosure of status time and place?
• Repeated disclosures
• Affects current and future relationships
• Policies on adoption for PLHIV

13
Landmarks

• December 2007 Amsterdam Statement
• People living with HIV have the freedom of
  choice regarding
• Consensual and pleasurable sexual expression.
• Reproduction, marriage and family planning, and
• The fundamental right to access sexual health
  information and comprehensive sexual health
  services.
• Sexual and reproductive health of women living
  with HIV/AIDS WHO, UNFPA
• Advancing the Sexual and Reproductive Health and
  Rights of People Living With HIV A Guidance
  Package - GNP, ICW, WHO, Engender Health, IPPF

14
So What?

• 1. Policy Criminalization and model AIDS laws
  need to be stopped
• 2. Programme Prevention aimed at PLHIV
• (a) Positive Prevention
• (b) Stigma work needs to be re-oriented (c)
  Self stigma
• 3. Personal PLHIV need to be recognised for
  their efforts in contributing to improvements in
  public health

15
PLHIV Stigma Index

• Partnership between IPPF, GNP, ICW and UNAIDS
• Aims
• Increasing advocacy and building the evidence
  base
• Operationalising the Greater Involvement PLHIV