Sexual And Reproductive Health And Rights Of People Living With HIV
1. The Right to reproduction, sexuality and desire
People Living with HIV (PLHIV) have the right to a pleasurable and enjoyable sexual life; the right to intimacy, to have children, and to love.
Sexual and reproductive health rights imply that the choices and decisions regarding our sexuality and reproduction should be ours to make – free of coercion and stigma.
People living with HIV have freedom of choice regarding consensual and pleasurable sexual expression; reproduction, marriage and planning a family.
HIV positive people also have the fundamental right to access sexual and reproductive health services without fear of being stigmatized or judged for their sexual and reproductive health choices.
2. Articulating the sexual and reproductive dreams and desires of people living with HIV
The sexual and reproductive health desires of people living with HIV are as varied as the epidemic itself.
The issues facing young people living with HIV as they embark on new relationships (repeated disclosure; potential sexual rejection because of HIV status, etc) are very different to the issues facing an HIV positive couple who may wish to conceive (health care provider attitudes; accessibility of appropriate services).
Prioritizing the sexual and reproductive health needs of people living with HIV will necessitate a shift in donor and foundation priorities.
People living with HIV need to guide this process in order to both avoid the 'cherry-picking' approach that dominates the current agenda for many donors and foundations and to clearly articulate what this agenda encompasses.
Addressing the sexual and reproductive health needs of people living with HIV means we also have to address the realities of men who have sex with men; injecting drug users and sex workers.
3. Linking HIV and sexual and reproductive health is part of the core business of the HIV community
HIV, sex and reproduction are intimately linked and at the core of any response to the HIV epidemic.
Acting on the links is not the sole mandate of the sexual and reproductive health movement.
The HIV community – particularly networks and associations of people living with HIV - need to embrace and guide this agenda.
It is important that HIV positive people help to lead this ‘linkages’ agenda and to proactively shape the content in order to respond to our sexual and reproductive health needs and rights.
Addressing the diverse range of issues within the sexual and reproductive health mandate will have to cover a diverse range of issues, from the fertility intentions of women living with HIV, to issues facing concordant and sero-discordant couples.
4. A shared responsibility for prevention
The responsibility for reducing transmission of HIV is a shared one and there should be no undue burden on people who are aware of their status.
Safer and responsible sexual behaviour is the responsibility of all partners – irrespective of status.
Promoting a culture of shared responsibility could also improve communication and equality within relationships. PLHIV have a shared responsibility to look after their sexual and reproductive health.
5. Challenging the changing face of stigma and discrimination
Stigma and discrimination have become more subtle.
While people living with HIV still have to contend with blatant discriminatory attitudes, it is imperative that innovative ways are found to document the changing face of stigma and discrimination in various settings.
Sexual and reproductive health care providers can and should play an active role in combating stigma.
Ensuring that the sexual and reproductive health and rights of people living with HIV are met will require that stigma is challenged in all its forms.
Tools such as The People Living with HIV Stigma Index allow us to establish a more nuanced evidence base for understanding and dealing with stigma.
Armed with this evidence people living with HIV should lead the advocacy effort to change policy and strategy and develop appropriate and accessible sexual and reproductive health programmes and interventions.