Sex and Childbearing After an HIV Diagnosis
Despite the enormous challenge that AIDS still poses to global health, for many people able to access antiretroviral treatment, HIV infection can now be managed as a chronic disease. Against this backdrop, a new policy brief from the Guttmacher Institute, entitled "Meeting the Sexual and Reproductive Health Needs of People Living With HIV," emphasizes that people living with HIV do not lose their desire to have sex and bear children, and outlines both the challenges and benefits of better meeting these needs.
"Because sex and childbearing are central to the lives of almost everyone, including those living with HIV, effective programs must take into account the sexual and reproductive health needs and aspirations of people living with HIV," says Heather Boonstra, senior public policy analyst at the Guttmacher Institute, who wrote the policy brief. Where sexual and reproductive health services tailored to the needs and circumstances of people living with HIV are in place, Boonstra notes, "not only do the lives of people with HIV stand to benefit, but global HIV prevention efforts will benefit as well."
The policy brief was published jointly by the Guttmacher Institute and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in collaboration with EngenderHealth, the Global Network of People Living with HIV/AIDS (GNP+), the International Community of Women Living with HIV/AIDS, the International Planned Parenthood Federation, the United Nations Population Fund (UNFPA) and the World Health Organization.
The policy brief examines a range of sexual and reproductive health needs and aspirations of people living with HIV as well factors that can limit access to such health care services, including:
- weak health care systems, where staff may not have been trained about HIV and sexual and reproductive health, and where supplies are often lacking;
- parallel programs separately focused on HIV services and on sexual and reproductive health services;
- taboos around sex, which impede the development of policies and programs addressing the sexual health needs of all people, particularly young people;
- gender inequalities, which may lead to women's lack of individual autonomy and control over sexual experiences; and
- HIV-related stigma and discrimination, including that among health care providers.
"People living with HIV continue to have satisfying sexual lives and make plans to have families," explained Kevin Moody, international coordinator of GNP+. "However, stigma and discrimination; lack of access to health workers trained in the sexual and reproductive health of people living with HIV; and the inability for people to even talk about sex make it difficult for people living with HIV to enjoy satisfying sex lives or to plan to exercise reproductive choices that are meaningful to them in their lives. The Guttmacher policy brief describes these challenges and describes how involving people living with HIV can help overcome them."
The brief underlines that people living with HIV may require specific sexual and reproductive health services. For example, compromised immune systems may leave people living with HIV particularly vulnerable to some sexually transmitted infections. Also, couples where one partner is HIV-positive face special challenges in trying to become parents and need help preventing transmission of the virus, and all HIV-positive women considering pregnancy need counseling and services to prevent perinatal transmission.
Nevertheless, the evidence shows that HIV infection need not prevent men and women from safely having sex, bearing children, using most modern contraceptives or accessing abortion services where legally available.
The policy brief stresses that in designing policies and programs to address the sexual and reproductive health needs of men and women living with HIV, policymakers, public health experts and national-level program planners must, of course, consider the best available scientific data. To be successful, they must also take advantage of the perspectives, expertise and accumulated experiences of people living with HIV.
"Associations and networks of HIV-positive people and community-based organizations run by and for people with HIV have a key role to play at all stages in the process - from program and policy design to the delivery and evaluation of sexual and reproductive health services," said Dr. Purnima Mane, UNAIDS' director of policy, evidence and partnerships.