THE EDITOR, Sir,

Patrice (not her real name) is a woman living with HIV. In a consultation with her doctor, she explained that she and her partner were planning to have a child. The doctor is said to have told her that she was wicked to want to get pregnant and pass the virus on to her child.

While our allies in the healthcare system are far greater than in previous years, Patrice’s story is one example of the discrimination that people living with HIV face from some healthcare workers.

With the widespread availability of antiretroviral treatments, people living with HIV have been living long and productive lives for years now. This includes healthy sexual and reproductive lives. Proper adherence to treatment and medical supervision significantly reduce the chances of transmitting the virus to one’s partner and virtually eliminates the chance that a woman will transmit HIV to a foetus. Despite these advances, there is significant evidence to suggest that some healthcare workers in Jamaica regularly coerce HIV-positive women to undergo tubal ligation (tie-off).

Women must never be denied the opportunity to give full and informed consent for sterilisation or other long-term contraceptive procedures because they are HIV-positive. Coerced sterilisation is a grave violation of the human rights of HIV-positive women, even classified by the OHCHR as an act of torture and cruel, inhuman, and degrading treatment. It manifests itself in ways that include offering financial incentives, deliberately providing misinformation, or using intimidation practices such as denying healthcare serves in an attempt to compel positive women to undergo the procedure.

This discriminatory practice is linked to the false belief that HIV-positive women are somehow not fit to be mothers or that HIV-positive women who become pregnant are irresponsible and incapable of managing their own healthcare needs and those of their families.

This practice also prevails because of weak or non-existent informed consent policies and procedures to protect patients’ rights or where medical personnel who violate such policies are generally not held accountable.

FORCED CONTRACEPTIVES

Additionally, there is evidence to suggest that HIV-positive women are also unwittingly placed on long-term contraceptives without consent or consultation. In a recent PLHIV training workshop, three different women shared their experiences of being told to go to ‘X’ clinic on ‘Y’ date to get a contraceptive method. The requisite consultation regarding their preferences and the details (side effects, etc) of type of method being issued were not provided in these cases.

In support of our members across the island and also the approximately 30,000 Jamaicans living with HIV, we encourage a joint approach from the Ministry of Health and Ministry of Justice to bring the practice of coerced tubal ligation to an end and make amends to the affected persons. Our first line of defence must be to provide continuous and comprehensive education and sensitivity training for our healthcare workers. This is a must if we are to make healthcare in Jamaica more effective, improve the lives of people living with HIV, and eradicate HIV altogether in Jamaica.

We must also be prepared to take action against violators of human rights and establish accountability, a process that includes introducing mechanisms so that violations are not permitted in the future.

In offering redress to persons affected by coerced sterilisation, JN+ advocates that we offer free sterilisation-reversal procedures. Law enforcement, including the judiciary, must also be trained to appropriately investigate, prosecute, and adjudicate allegations of violations of reproductive rights, especially as they relate to HIV-positive women.