Regina Maria Barbosa

Access to safe abortion: building choices for women living with HIV and AIDS

In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of all pregnancies worldwide in 2008, 41% were reported as unintended or unplanned, and approximately 50% of these ended in abortion. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long-term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights.In this paper, we explore the existing evidence related to global and country-specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa as examples of three countries with different conditions regarding womens access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non-implementation of the law, and a rather liberal setting.Similarities and differences are discussed, and we further outline global and country-specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.

Induced abortion in women of reproductive age living with and without HIV/Aids in Brazil

This study aimed to identify and compare the characteristics of women living (WLHA) and not living with HIV/AIDS (WNLHA) regarding the report of lifetime induced abortion. Data from 1,777 MVHA and 2,045 MNVHA were collected between November 2003 and December 2004 during a cross-sectional study carried out in 13 municipalities of Brazil. After adjustment for confounding variables, 13.3% of MVHA versus 11.0% of MNVHA reported induced abortion in their lifetime (p>0.05). In multivariate analysis, independent correlates of lifetime induced abortion for both groups were: age, with older women reporting greater proportions of reporting induced abortion, living in the North region of Brazil, age at sexual debut (up to 17 years old), having three or more lifetime sexual partners, having ever used drugs and self-reporting occurrence of sexually transmitted diseases. The results suggest that, in general, the characteristics of women who reported induced abortion in both groups were similar, and that the contexts associated to HIV infection and to reproductive practices and decisions among women might share similarities.

Notes on the female condom: experiences in Brazil

A nationwide effort to introduce the female condom (FC) into public health services was undertaken in Brazil in 1998–99. To this end, the Ministry of Health sponsored a national research group of public health professionals, aided by local field workers and supervisors, to conduct a preparatory study at 20 sites in six cities. Clinic health workers were trained to conduct the study. Following an educational session, 2382 women volunteered to use the FC and to report their experiences at follow-up. Among those seen at 15 days, 1782 had used the FC at least once; among those seen at the 90-day follow-up, 1453 women had used it at least once, while 1296 of them liked it and wished to continue its use. Among these 1296 women, barrier use at last intercourse (either with a male or a female condom) was more than double at 90 days what it had been at baseline: 70% compared with 33%. Clinics providing active health-education activities achieved higher rates of follow-up and of FC acceptability. These findings suggest that in Brazil, the introduction of the FC at public health centres could lead to high initial adoption rates and that continued use would be effective in encouraging safer sex. The level of health education and type of clinic are likely to influence the effectiveness of a future programme.

[Women who have sex with women: estimates for Brazil].

This paper analyzes the proportion of Brazilian women who have sex with women, considering three time periods. The data are from a national population-based survey from 1998. The proportion of the female population who reported having any same-sex relations during their lifetime decreased from 3% to 1.7% in the previous five years and remained at 1.7% in the last year. Comparing the data by gender, the results suggest that women and men have different patterns of homosexual and heterosexual experiences over the course of their lives.

Cultura médica e decisões reprodutivas entre mulheres infectadas pelo vírus da Aids

As gestantes infectadas pelo virus da Aids defrontam-se com um conjunto de informacoes, prescricoes e praticas que tornam este periodo particular em relacao a outras gestacoes e experiencias. O presente artigo busca evidenciar os fatores que condicionam as escolhas reprodutivas das gestantes HIV+, em especial no que se refere ao tipo de parto e decisao por esterilizacao feminina adotado, bem como suas implicacoes. Os dados apresentados resultam de uma pesquisa desenvolvida nas cidades de Sao Paulo e Porto Alegre, onde foram entrevistadas sessenta mulheres. A condicao de soropositividade para o HIV faz com que o parto seja percebido, pelas gestantes, como uma prescricao medica, deixando o desejo em segundo plano. Mas, alem deste fator, o tipo de servico ao qual a gestante encontra-se vinculada aparece como determinante, tanto para a indicacao fornecida como para sua concretizacao ou nao. O fato das expectativas relacionadas ao parto serem determinadas por uma prescricao medica, pouco dependente da vontade ou experiencias anteriores, faz com que para muitas mulheres esta experiencia seja percebida como mais dificil que os partos anteriores ou pior que o esperado.

Sterilisation and sexual behaviour among women in Sao Paulo Brazil.

Abstract This study of sexual behaviour in relation to HIV/STD infection risk among sterilised and nonsterilised women in Sao Paulo shows that sterilised women are less likely to use condoms to protect themselves against STDs. Other differences between the two groups of women indicate that this group of women may have additional difficulties negotiating changes in sexual practices. Sterilisation is very common among women with a lower level of education and who are married, a profile which is highly associated with HIV infection among women in Sao Paulo. In our sample, no sterilised woman and less than one in five non-sterilised women had used a condom sometimes or always in the past month for protection against HIV and STDs. Public health messages and outreach strategies to reduce the risks of HIV, STDs and cervical cancer and to increase condom use should address women who have been sterilised as well as those who have not.

Motivos e circunstâncias para o aborto induzido entre mulheres vivendo com HIV no Brasil

The impact of HIV/AIDS infection on the decision of women living with HIV/AIDS to interrupt a pregnancy remains an understudied topic. In an effort to understand the influence of HIV/AIDS diagnosis on abortion practices, a qualitative study was carried out in seven Brazilian municipalities with women living with HIV/AIDS who reported inducing an abortion at some point in their lives. This study presents the analysis of interviews with thirty women who became pregnant after diagnosis. The results show that for some women, infection was the primary motive for terminating their pregnancy, while for others, the motives for abortion were predominantly related to life circumstances. The decision to abort due to HIV infection is not the same for all women. It is related to the timing of the diagnosis and other aspects of the womans life during her pregnancy, such as the relationship with her partner, her job and family support. The results suggest the need for more attention from health services to the reproductive decisions of women living with HIV/Aids; the incorporation of men into sexual and reproductive health prevention actions; and a deeper discussion of the illegality of abortion in Brazil and its harmful consequences for women, men, and children.

Between Personal Wishes and Medical “Prescription”: Mode of Delivery and Post-Partum Sterilisation among Women with HIV in Brazil

Abstract HIV-positive women are confronted during pregnancy with a range of medical information and prescriptions that substantially affect the experience of pregnancy and birth. Based on antenatal and post-partum interviews with 60 HIV-positive pregnant women from São Paulo and Porto Alegre, Brazil, this article presents evidence of some of the factors that affect mode of delivery and access to post-partum sterilisation, and the implications of these. Whether women gave birth vaginally or by caesarean section was medically prescribed, with womens own preferences taking second place. Some were advised that caesarean section was the only option with HIV in pregnancy; others were told it should be used only for medical indications, even if the woman wanted to be sterilised at the same time. The women in Porto Alegre were less likely to get a sterilisation than those in São Paulo, even with caesarean section, as sterilisation was not encouraged locally. Many of the women who accepted a caesarean had been convinced before they gave birth that it was the best choice for them, either because it reduced the risk of perinatal HIV transmission or because it facilitated tubal ligation, or both. However, after they gave birth, the women judged their experience of delivery and the post-partum period mainly in comparison to previous deliveries, and many of them viewed the birth experience with HIV as more difficult than previous deliveries and worse than they had expected.

Opções contraceptivas e vivências da sexualidade: comparação entre mulheres esterilizadas e não esterilizadas em região metropolitana do Sudeste do Brasil

A cross sectional study involving 357 women, 174 of them sterilized and 183 non-sterilized, with a view to comparing their sexual and reproductive behaviour, was undertaken. The questionnaire was based on previous focus group discussions with both women and men, to find out the best way to approach related questions. The results show that sterilized women-who are older and more often have steady partnerships than non-sterilized women-fulfil traditional gender roles more closely than the others. Furthermore, no sterilized woman had used the condom in the month prior to the interview. It is suggested that public messages for the prevention of the spread of the HIV, sexually-transmissible disease and cervical cancer should target women who have been sterilized for the purpose of increasing the use of the condom in accordance with specific strategies.

UNGASS-HIV/AIDS: a review of the Brazilian response, 2001-2005

Recognizing the HIV/AIDS pandemic as an unprecedented worldwide emergency and one of the greatest challenges to life and the enjoyment of human rights the United nations called on member states to reflect on this matter. In June 2001 around 20 years after the first AIDS cases were recorded the United Nations General Assembly Special Session on HIV and AIDS (UNGASS HIV/AIDS) was held in New York. The Session culminated in the drafting of the Declaration of Commitment on HIV and AIDS: a document that reflected the consensus between 189 countries including Brazil and stated some essential principles for an effective response to the epidemic. The Declaration recognized that economic racial ethnic generational and gender inequalities among others were factors that boosted vulnerability and whether acting separately or in synergy favored HIV infection and the onset and evolution of AIDS. The Declaration of Commitment on HIV and AIDS has become transformed into a tool for reaffirming the urgency and necessity of promoting the solidarity that the epidemic demands. It aims towards better management of the actions and resources destined for controlling HIV and AIDS and towards social control over public HIV/AIDS policies. (excerpt)