Coercive reproductive healthcare practices reported by many women living with HIV

Women with HIV are at an increased risk of reproductive coercion by healthcare professionals across sub-Saharan Africa, eastern Europe and central Asia. Sex workers, women who use drugs and migrants who are also HIV positive are more likely to receive sub-standard and stigmatising reproductive care. This was reported by Dr Carrie Lyons from the Johns Hopkins School of Public Health at the 12th International AIDS Society Conference on HIV Science (IAS 2023) in Brisbane, Australia.

The data were gathered from the People Living with HIV Stigma Index 2.0, which was developed by the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV (ICW), the International Planned Parenthood Federation (IPPF) and the United Nations Programme on HIV/AIDS (UNAIDS). The Stigma Index is an international standardised tool enabling people with HIV to self-report the stigma and discrimination they experience. The team looked at these data, focusing on the accounts of cisgender women who had been diagnosed with HIV for at least one year. Data were collected between 2021 and 2022. The team adjusted for confounding variables.

Coercion relates to pressuring individuals to have reproductive interventions without their free and informed consent. The team looked for experiences of coercive practices in relation to family planning or pregnancy, and especially for experiences of forced or coerced sterilisation.

The 11 sub-Saharan African countries included in this study were Angola, Benin, Burkina Faso, Cote D'Ivoire, Ghana, Kenya, Mauritania, Nigeria, Lesotho, Togo and Zimbabwe (n=10,719). The five eastern Europe and central Asian countries were Belarus, Kazakhstan, Kyrgyzstan, Russia and Ukraine (n=2075).

Participants were asked about reproductive coercion in the previous year. Generally, violation of reproductive rights was common across both regions:

• 1% and 3% experienced forced sterilisation in sub-Saharan Africa and eastern Europe and central Asia respectively.
• 2% and 4% experienced coerced family planning in sub-Saharan Africa and eastern Europe and central Asia respectively.
• 5% and 10% experienced coercion related to pregnancy in sub-Saharan Africa and eastern Europe and central Asia respectively.

There were particular risks for sub-groups of women with HIV. In sub-Saharan Africa, women who use drugs and migrant workers disproportionately experienced coerced family planning, pregnancy and sterilisation from healthcare professionals. Specifically, migrants and women who use drugs were seven times and three times more likely to experience coerced sterilisation respectively.

In eastern Europe and central Asia, sex workers and women who use drugs were at increased risk of coercion related to contraception by healthcare professionals (1.5 and 1.77 times respectively). Moreover, young women were at increased risk for coercion related to pregnancy (1.75 times).

The team analysed the data according to single identities; Dr Lyons stated that an intersectional analysis would likely further highlight how multiple identities compound women’s vulnerabilities. Dr Lyons stressed the urgent need to address coercion across various settings to improve healthcare quality. Reproductive coercion worsens individual HIV treatment outcomes and threatens the wider HIV response. The structural violence that women with HIV face, especially within the context of HIV criminalisation, has implications for access to health care and quality of life. The team call for non-discrimination protections for women living with HIV to prevent reproductive coercion by healthcare professionals and allow accountability when it occurs.