Sex, Science-- Silence!?!?! Achieving Sexual Rights and Reproductive Justice for Women Living With HIV September 30, 2012 U.S. Conference on AIDS Naina Khanna Policy Director Women Organized to Respond to Life-threatening Diseases (WORLD) 1

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HIV status as a tool of manipulation, coercion 4

HIV status as a tool of manipulation, coercion 5

“But I also know that this woman actually has control over what ultimately is a life or death decision with the stroke of her pen. And clearly she is in a bad mood… What I have is a very expensive medical condition and no way to pay for it… it is that simple. I need help. We as women living with HIV are driven into poverty and held there, and we are drowning.” HIV status as a tool of manipulation, coercion 6

Recent Trauma  4x the rate of ART Failure HIV status as a tool of manipulation, coercion 7

Rates of trauma and PTSD in HIV+ women are much higher than national averages HIV status as a tool of manipulation, coercion 8

You can’t always take sex out of conception Even if the patient’s goal is conception, the provider’s goal is to ensure whole health… that includes healthy sexuality and eroticism. People living with HIV are sexual beings If a discussion about conception minus sex is happening, it’s important to start with understanding why eg. --> same gender loving? --> fertility concerns? --> individual vs couple. 9

N = 181 10

Motherhood is a socially valued identity Increasingly “parenthood” For many WLHIV, motherhood may be the only socially valued identity available to them (Barnes, et al 2009). - Critical for providers to understand motivation, including cultural factors related to conception for PLHIV 11

There is very little literature on this subject. 12

- PWN survey respondent “I was told by several providers to abort my pregnancy. I was in my 2nd trimester before I knew I was pregnant. I ran out of many a doctor’s office in tears after being told I was selfish, or that ‘if that was my wife, I’d make her have an abortion.’” - PWN survey respondent HIV status as a tool of manipulation, coercion 13

- PWN survey respondent “Being forced to have an abortion and getting my HIV diagnosis at the same time was like a double trauma. Where are the mental health services for women in my situation?’” - PWN survey respondent HIV status as a tool of manipulation, coercion 14

What about people other than cisgender women? There is very little literature on this subject. 15

Eliminate HIV stigma & related stigmas The way forward: Eliminate HIV stigma & related stigmas - homophobia, transphobia, laws that criminalize or discriminate Women-controlled prevention options Fully integrate sexual and reproductive healthcare and trauma screening & recovery into HIV prevention and care N = 181 16

Thank You Naina Khanna Policy Director U.S. Positive Women’s Network nkhanna@womenhiv.org 510-681-1169 For more info: www.pwn-usa.org 17