Sat | Feb 23, 2019

Ricky Pascoe | Don’t coerce women living with HIV to tie off

Published:Tuesday | January 22, 2019 | 12:13 AM

Patrice (not her real name) is a woman living with HIV. In a consultation with her doctor, she explained that she and her partner were planning to have a child. The doctor is said to have told her that she was wicked to want to get pregnant and pass the virus on to her child.  

While our allies in the healthcare system are far more numerous than in previous years, Patrice’s story exemplifies that people living with HIV still face discrimination within the healthcare sector.

With the widespread availability of antiretroviral treatments, people living with HIV have been living longer and more productive lives for years now. This includes healthy sexual and reproductive lives. Proper adherence to treatment and medical supervision significantly reduce the chances of transmitting the virus to one’s partner and virtually eliminate the chance that a woman will transmit HIV to a foetus. Despite the wide acceptance of this fact, there is significant evidence to suggest that some healthcare workers in Jamaica regularly coerce HIV-positive women to undergo tubal ligation (‘tie off’) up to this day.

GRAVE VIOLATION OF HUMAN RIGHTS

Women must never be denied the opportunity to give full and informed consent for sterilisation or other long-term contraceptive procedures because they are HIV positive. Coerced sterilisation is a grave violation of the human rights of women living with HIV (WLHIV), and it is even classified by the Office of the United Nations High Commissioner for Human Rights (OHCHR) as an act of torture and cruel, inhumane, and degrading treatment. It manifests in ways that include offering financial incentives, deliberately providing misinformation, or using intimidation practices, such as denying healthcare serves in an attempt to compel WLHIV to undergo the procedure.

This discriminatory practice permeates from the false belief that HIV-positive women are somehow not fit to be mothers or that HIV-positive women who become pregnant are irresponsible and incapable of managing their own healthcare needs and those of their families.

This practice also prevails because of weak or nonexistent informed-consent policies and procedures to protect patients’ rights and because medical personnel who violate such policies are generally not held accountable.

There is the infamous example in Kenya, where WLHIV were offered US$40 by an international non-profit to have an intrauterine birth control device (IUD) implanted. While the Jamaican context has yet to produce any such egregious example, positive Jamaican women still experience varying levels of coercion from medical personnel across the island.

Case in point: Samantha (not her real name) is a member of a local HIV clinic and was referred to an antenatal clinic when she became pregnant. At her antenatal clinic appointment, she was asked by her doctor if her husband was also HIV-positive and she responded yes. The doctor then asked if she was going to get a ‘tie-off’ after her delivery.

Samantha asked the doctor why that suggestion was made, and the doctor said that they would have to talk more about it later. At the end of the conversation, the complainant said she was very worried about the doctor’s remarks.

She sought further information from another doctor at the health facility, who told her that it is common practice to recommend a ‘tie-off’ after the second pregnancy for all mothers. The manner in which the ordeal unfolded led Samantha to believe that the recommendation was due to her HIV status.

Additionally, there is evidence to suggest that HIV-positive women are also unknowingly placed on long-term contraceptives without consent or consultation. In a recent training workshop with persons living with HIV, three different women shared their experiences of being told to go to ‘X’ clinic on ‘Y’ date to get a contraceptive. The requisite consultation regarding their preferences and the details (side effects, etc) of the type of contraceptive method being issued was not provided in these cases.

JOINT APPROACH FROM MINISTRIES

In support of our members across the island, and also the approximately 34,000 Jamaicans living with HIV, we encourage a joint approach from the Ministry of Health and Ministry of Justice to bring the practice of coerced tubal ligation to an end and to make amends to the affected persons.

Our first line of defence must be to provide continuous and comprehensive education and sensitivity training for our healthcare workers. This is a must if we are to make healthcare in Jamaica more effective, improve the lives of people living with HIV, and eradicate HIV all together.

We must also be prepared to take action against violators of human rights and to establish accountability, a process which includes introducing mechanisms to avoid future violations.

In offering redress to persons affected by coerced sterilisation, the Jamaica Network of Seropositives advocates that we offer free sterilisation reversal procedures. Law enforcement, including the judiciary, must also be trained to appropriately investigate, prosecute, and adjudicate allegations of reproductive-rights violations, especially as they relate to HIV-positive women.

- Ricky Pascoe is the president of the Jamaica Network of Seropositives (JN+). Email feedback to columns@gleanerjm.com.