AIDS Conference Exclusive: HIV Diagnosis and Forced Sterilization in Mesoamerica

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

A quarter of HIV-positive women surveyed in Mesoamerica reported health care workers pressured them into sterilization, recent research shows. This rate was consistent across the four countries (Mexico, Nicaragua, El Salvador, and Honduras), all races, and education and socioeconomic levels in the study, showing distinct, consistent discrimination against women with HIV. This is a serious violation of reproductive rights, especially in light of advances in treatment and prevention of HIV.

“It’s really unthinkable that women living with HIV are being pressured and forced into sterilization when treatment almost eliminates the possibility of mother-to-child transmission… and also provides options for safer conception and pregnancy,” says Dr. Tamil Kendall (Reuters), lead research for this project and a Canadian Institutes of Health Research postdoctoral researcher with the Women and Health Initiative and a Takemi Fellow at the Harvard School of Public Health. But, Kendall relays, “We found that only slightly more than half of the women who participated in the study were told that there exists an intervention—a regimen of AIDS-fighting antiretroviral drugs—that can reduce the probability of HIV mother-to-child transmission by 98%–99%.” Even without any intervention, an HIV-positive woman has only a 15-45% chance of transmitting the virus to her newborn. So why are health workers pressuring women to be sterilized?


Kendall said, “Even though our knowledge is growing about how safe conception and pregnancy can be with current HIV treatments; about the possibility of dramatically reducing transmission of HIV to a partner; and about interventions to help people with HIV conceive safely, this knowledge is still often ignored as a routine part of HIV care—even in the U.S. Reproduction among people with HIV continues to be very stigmatized.”

The lengths to which health workers go to pressure or coerce women to sterilize are drastic. “Women are told that if they have another pregnancy that either they will die or their children will almost surely acquire HIV and die,”  Kendall said (Reuters). Some women are even denied medical care if they do not consent to sterilization. One 19-year old woman from El Salvador said, “The nurses forced me to sign. They asked me more than three times and threatened not to perform the cesarean. Because of the pressure, I had no option but to sign.” Even more extreme, some are sterilized without any consent or knowledge of the procedure.

These findings have significant implications for policy advocates, makers, and enforcers. “There’s also a great need to evaluate how health care providers are held accountable—in the courts, for example—for violating the reproductive rights of women with HIV. And it’s important to work with policy makers, because they are the ones who ultimately need to hold institutions accountable,” Kendall states. Continued research and policy advocacy is needed to produce change and respect for HIV-positive women’s reproductive rights.

The unique aspect of this research was it was community-based and broadly collaborative. Led by Dr. Kendall, the research was initiated by Balance, a Mexican NGO, and the International Community of Women Living with HIV and AIDS. More than 60 peer researchers, most of whom are women leaders living with HIV, collected data. In addition, research and policy advocacy are routinely integrated through in-country presentations to participating organizations and national decision-makers, the formation of a regional manifesto, and advocacy with the Commission on the Status of Women and other UN bodies.

Kendall would like to recognize and thank all the organizations that participated in this research.

Want to learn more about Dr. Kendall’s Research? Read interviews with her by the Harvard School of Public Health and Reuters. Want to learn more about HIV/AIDS and maternal health? See our topic page.