Positive and pregnant in Asia A peer-led study among women living with HIV in Bangladesh, Cambodia, India, Indonesia, Nepal, Viet Nam Susan Paxton PhD, Advisor, APN+ Baby Rivona, Coordinator, IPPI Indonesia Washington 2012

Study size 757 questionnaires: Bangladesh 33; Cambodia 200; India 172; Indonesia 109; Nepal 40; Viet Nam FGDs: Bangladesh 2; Cambodia 2; Nepal 2; Viet Nam 4 (total 100 participants) 17 interviews: Cambodia 6; India 6; Indonesia 5 Inclusion criteria: HIV-positive, >16 years, pregnant within past 18 months

Study sample Mean age: 29 years (range yrs) Residence: 57% urban; 43% rural Marital status: 77% married/live with partner, 21% no partner/widow, 2% never married Mean number of children: 1.7 (range 0-8) Income: 53% dependent on family Timing of HIV diagnosis: 56% before pregnancy, 27% during, 10% after delivery

Counselling Over 70% of women received pre- and post-test counselling BUT: > 50% of Indian women tested in pregnancy did not get pre-test counselling Only 9% of women who said their test not voluntary received post-test counselling Most women are strongly discouraged from becoming pregnant by health care workers Women highlighted the importance of having trained HIV-positive female counsellors

Antiretrovirals Majority (64%) were on ARVs: 41% started before pregnancy; 51% during; 8% after delivery 29% were still using Stavudine/d4T (Viet Nam 32%; Cambodia 31%; India 19%; Indonesia 15%) Only 7% initiated ARVs at CD4 >350; majority started at CD4 <200 Cost of transport is the major barrier in accessing health care

Contraception Condoms are only contraception promoted among women with HIV - not used consistently; partners object 37% of women said pregnancy was unwanted Women need methods they can control – IUDs, pills, injectables, female condoms

Sterilisation Of 426 deliveries, 37% via caesarean ( Cambodia 7%, Nepal 33%, India 36%, Vietnam 41%, Bangladesh 57%, Indonesia 67% ) 30% women encouraged to consider sterilisation, most commonly by gynaecologists Strong correlation between caesarean sections and recommendations for sterilisation Some women do not know whether they were sterilised during their caesarean

Discrimination "During delivery the doctor wanted to put on two sets of gloves. He had put up on one set but the baby was already coming out and the doctor tried to push it back in so he could put on another set of gloves.“ (Saru, Nepal) "When I was delivering the doctor left me alone and the baby came and just fell down.“ (Xuan, Viet Nam) Some women avoid health care during pregnancy because of discrimination

Key recommendations Uphold sexual and reproductive rights of women with HIV Invest in positive women's organisations Expand counselling by positive women Improve sensitivity of maternal health workers Ensure social security for women to access health care Full report: “Positive and pregnant: How dare you” available at

Thank You