HIV/Aids: Women's Broader Health and Sexual Needs Should Be Considered
BYLINE: Marion Stevens
SATURDAY was an opportunity to reflect on our achievements and challenges on World Aids Day, and the particular treatment experience and needs of HIV-positive women would benefit from consideration. Since more women than men are now being infected, it is illustrative to use a sexual and reproductive health and rights lens on the field of HIV/Aids care.
The Health Systems Trust's South African Health Review 2007 - which was launched last week in Cape Town - focuses on the role of the private sector in contributing to the greater health system.
In its chapter on HIV/Aids, STIs and TB, the report documents how the private sector has been the vanguard in the provision of treatment and has significant experience in managing clients who are HIV-positive in disease management programmes. Yet it is clear that the sexual and reproductive needs of women are not addressed.
There has long been a focus on the prevention of perinatal transmission, but treatment needs to be aimed not only at those with HIV-negative babies.
The private sector neither provides nor pays for the particular fertility needs of women, either in preventing pregnancy through contraception, choosing to get pregnant safely or terminating unwanted pregnancies.
These findings are not peculiar to the private or even public sector but are also noted as international trends.
Two forms of highly active anti-retroviral therapy (Haart) - tenovofir and evafirenz - are contra-indicated in pregnancy and breast feeding, so there is a lot of reliance on injectable contraceptives to ensure that women do not receive them while pregnant or during the postnatal period.
Injectable contraceptives are effective in preventing pregnancy, but do not enable women or men to regularly negotiate safer sex or create a culture of having to regularly negotiate safer sex.
In treatment IUCDs (intrauterine contraceptive devices) are provided but require careful monitoring to ensure that infections are treated in a timely manner.
HIV-positive women also require better options and information on contraception.
Male circumcision has emerged as a prevention opportunity in possibly helping to prevent female-to-male transmission through vaginal intercourse.
In considering this as an intervention, however, one must not lose sight of the possible challenges this might impose on women. …