1. + Forced And/Or Coerced Sterilisation of Women Living with HIV in Public Health Facilities ARASA PARTNERSHIP FORUM 2015 MARIDADI.K. Bernard Gift PROGRAMS ASSISTANT ICWEA www.icwea.org

2. Presentation at the ARASA Partnership Forum 2015 15 th – 16 th April 2015 The International Community of Women Living With HIV&AIDS Eastern Africa

3. + The International Community of Women living with HIV Eastern Africa (ICWEA) is a registered regional advocacy network and membership based organisation” Founded in 2005 to give visibility to women living with HIV. ICWEA believes that gender inequalities and the limited access to sexual & reproductive health & rights for women are at the heart of the HIV epidemic. Our advocacy is based on evidence of our daily lived experiences and we use participatory processes to addresses the priorities of women living with HIV, including young women. Background

4. + A world where all HIV positive women: Have a respected and meaningful involvement at all political levels, local, national, regional, and international, where decisions that affect our lives are being made; Have full access to care and treatment; and Enjoy full rights, particularly sexual, reproductive, legal, financial and general health rights; irrespective of our culture, age, religion, sexuality, social or economic status/class and race. Vision

5. + Where We Work in Africa

6. + Creating safe spaces for women living with HIV to share their experiences; What We Do a young woman making a presentation during a meeting of young women living with HIV

7. + What We Do Cont’d... Giving visibility to WLHIV and advocate for comprehensive quality Prevention, Treatment, Care & Support Services ICWEA at ICASA and facilitating a SRHR session at WNZ

8. + What We Do Cont’d… Addressing Gender and SRHR at the heart of HIV&AIDS pandemic

9. + What We Do Cont’d…… Advocating for the protection of the Human Rights of Women living with HIV including young women

10. + What We Do Cont’d… Challenging unfavourable policies, laws and legal environments

11. + What We Do Cont’d… Representing Women living with HIV and our issues ICW at a Meeting with Obama Administration Staff

12. + What We Do Cont’d... Building capacity of WLHIV including young women ICWEA hosting a meeting of key African Advocates

13. + What we do Cont’d…. Challenging policy, programmes and funding decisions, actions and mis-actions

14. + What We Do Cont’d… Advocating for increased financing/fundi ng particularly by our governments & country funding mechanisms

15. + Forced and/or Coerced Sterilisation: Key Definitions  Sterilisation: may be defined as the performance of a medical procedure which permanently removes an individual’s ability to reproduce, and/or the administration of medication to suppress menstruation.  “Forced sterilization” is a situation where a woman is operated on without her knowledge or by force  “Coerced sterilization”: is a situation where a woman is pushed or persuaded to sign a consent form during distressing circumstances—such as during labor or without being properly informed.

16. + Is Coerced and/or forced Sterilisation happening?  From 2005 onwards, several cases of forced sterilization of women living with HIV have been reported for example in Kenya, Uganda and Namibia among others.  In 2007, for instance, NACWOLA reported a case involving sterilization of HIV positive women; one of these women was a Sudanese Refugee and the other two IDPs affected by the war in Northern Uganda.

17. + Coerced &/or forced sterilisation real  Testimonies from participants during the SRHR trainings under the ICWEA/ICWSA NORAD funded project-2010-2012. (Political Voice for women living with HIV 2010)  In the PLHIV stigma index study (NAFOPHANU, 2013- Uganda), 34% of PLHIV involved in the study reported having been advised by health professionals not to have children after being diagnosed HIV positive.  11% of the respondents reported to have been forced by health workers to undergo sterilization because of their HIV positive status  Note!! 1110 respondents were determined to represent approximately 1.2m PLHIV in Uganda at the time.

18. + Coerced &/or forced sterilisation real According to the PLHIV Stigma index assessment by NEPHAK -Kenya 2011;  28.1% of 1086 respondents reported being advised by a health care professional not to have child  8.6% reported having been coerced In to considering sterilisation  16 women (2.34% ) had felt /been coerced by A health professional Into termination of A pregnancy within the past 12 months.

19. + ICWEA unveils first cases of coerced & forced sterilisation in Kenya & East Africa Through our SRHR programme (2010 – 2012 in East Africa, WLHIV unveiled that they were being forced and coerced into sterilisation and this was being heard for the first time. In Kenya ICWEA hosted a Policy dialogue followed by a media briefing & during the dialogue meeting with several partners including funders one partner Open Society Institute Eastern Africa (OSIEA committed to supporting ICWEA get to the bottom of this but later on worked with Africa Gender & Media Initiative & over 50 cases of WLHIV who were sterilized were revealed. “Robbed Of Choice”

20. + How does it happen?  During an emergency cesarean section  Some HCW’s belief that WLHIV should not have children or that they had too many children already.  Spouse and/or parents gave consent for sterilization on behalf of the women.  Misinformation by some HCW’s about their FP choices or the risks of future pregnancies to their health and that of their baby.

21. + Impact At ICWEA, we recognise that the practice constitutes one of the worst form of violence for Women and violates multiple human rights,  This action undermines the self-worth of WLHIV and sense of identity as women and mothers.  Increasing women’s vulnerability to intimate partner violence  Long term negative impact on mental health, wellbeing, access to land and social economic opportunities.

22. + What is being done  Strengthening institutional capacity of HIV-positive women’s networks to document, monitor and publicize HR violations Capacity building trainings  Dialogue meetings with Health workers  In Kenya Litigation has been opted and Kenya Legal Netwok on AIDS working hand in hand with WLHIV, ICW Kenya Chapter and ICWEA  In Uganda, ICWEA has undertaken a national research and data is currently being analyzed

23. + Underlying challenges  Its difficult to find women willing to endure the difficult process of litigation  Lack of recognition amongst WLHIV & HCW of what constitutes SRHR violations  Unfavorable legal environments  Denial from authorities that this is a systemic pattern, focus on individual instances  Ignorance of the women’s SRH and rights makes them more vulnerable to this violation!  Many women who are vulnerable due to HIV infection, are not aware of the various laws and policies that protect them from violence.

24. + Recommendations Empower women living with HIV to understand their rights, fend.and demand for them Family planning options must be available for all including WLHIV and they should make their informed choices Deal with the negative attitudes of some Health workers towards WLHIV reproductive choices Support WLHIV to access redress, support and care for those who have undergone C/F S Governments should put in place SRH policies, disseminate to them and human rights charters, etc

25. + Conclusions Sterilization without informed consent is part of a pattern of discriminatory violations of SRHR experienced by women living with HIV. This has been documented by ICW networks in at least 30 countries. Despite differences of geography, the stories of women living with HIV who have experienced coercive and/or forced sterilization are very similar and are frequently reported in the context of prevention of vertical transmission.

26. + ICWEA@10: “Celebrating Women living with HIV” 10 Years of Excellence in International, Regional and National Advocacy!!!!

27. + ICWEA’s New Home

28. + Lillian with Stephen Lewis

29. + HE Festus Mogae-Botswana

30. + Other Guest in attendance

31. + UNAIDS Country Director, Board Member & HE Festus Mogae