In Uganda, women living with HIV are experiencing sexual and reproductive health and rights violations in various clinical settings, according to a new report launched at the International Conference of AIDS and STIs in Africa.
The report is based on research conducted last year by the International Community of Women Living with HIV Eastern Africa, with assistance from the Link Up project and STOP AIDS NOW. It examines violations of sexual and reproductive health and rights (SRHR) of women living with HIV while they were seeking services in clinical settings in Uganda, and includes scrutiny of sterilisation, both coerced and forced.
The research was carried out across Uganda and conducted with involvement of research assistants who were mainly young women living with HIV. They were trained to develop research questions and analyse the data.
Brenda Facy Azizuyo, one of the research assistants, felt she learnt a lot from her role in the project. She said: “You learn how to communicate with a person, get detailed information and you learn how to unpack someone’s experiences that you would not have expected.
“It was a fun experience, but it was hardworking stuff, you really need to put in a lot of effort and keep all you have been taught in your mind. How to analyse the screening papers which helped us so much to get the real people whom we wanted, because sometimes some people would just come because they wanted to get something, but that screening paper helped us to pick them out.”
Lack of communication fuels violations
The researchers spoke to more than 700 women living with HIV and their partners, health service providers, government representatives and civil society organisations. They found that sexual and reproductive health violations are happening at home, in the community and in clinical settings.
For violations in clinics the research found that most of these violations were due to women not being adequately informed and not given enough time to make important decisions around sterilisation, family planning and abortion. Much of this comes down to communication, or lack of it.
One of the study participants had her fallopian tubes tied, but initially she had understood that it could be undone as soon as she wanted to have another baby. The health worker had tried to explain to her in the local language but they used the wrong word. The woman consented to get sterilised but with the understanding that she would be able to have more babies whenever she wanted.
The study found 72 reported sterilisations, including 20 women who had been coerced or forced to undergo this irreversible operation, with family members who consented on their behalf.
Nienke Westerhof, advisor on SRHR and gender for STOP AIDS NOW!, said: “This amounts to a rights violation, as every woman whether or not they are living with HIV, or if they are a sex worker, has the right to have a baby whenever they want to and with whomever they want.”
Training needed to avoid violations
Clearly more needs to be done to raise awareness among all women, and their partners, of their sexual and reproductive rights, and to ensure they are able to demand these rights.
Westerhof stressed that training must also be given to health workers so they understand it is their job to fully explain to women their options and rights, and to give them enough time to make informed decisions as well as supporting whatever decision they make.
She also called for the guidelines and protocols to be reviewed as health workers are often trying to do what they think is best when they coerce or force women into a certain course of action.
“Sometimes when a woman is delivering and it is an emergency, they do what they think is the best for the woman, which could be to sterilise her for instance,” said Westerhof.
This is particularly a problem in understaffed clinics and the guidelines should provide a clear path on what steps are to be undertaken during emergencies.
Petition to end violations
As well as presenting their new report on 1 December, the International Community of Women Living with HIV Eastern Africa also launched a campaign, petitioning people to support women and stop the violations. For this to succeed health providers, governments, women living with HIV, men and communities will need to work together.
Shaun Mellors, associate director Africa at the International HIV/AIDS Alliance, said: “It is a clear violation of women’s rights and it needs to be stopped as a matter of urgency. It is important for people to understand that women have the right to decide what happens to their bodies and as men it is not our decision, we need to support our women in the choices that they make about their sexual and reproductive health and rights.”
On changing people’s perspective on forced sterilisation, Azizuyo said: “It is ongoing, it is a process, it is not a one-off thing, like if you say stop, and they will stop. To change a person’s character takes a lot of time and it needs a lot of effort from different directions not only from us but also from the community members, health workers, teachers and their bosses also because bosses are the ones who will direct them to do some things. After ICASA, we are going back to Uganda to implement more on this.”
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