One in four HIV-positive women in Central America pressured to sterilise - study

by Katie Nguyen | Katie_Nguyen1 | Thomson Reuters Foundation
Wednesday, 23 July 2014 07:23 GMT

In a 2010 file photo, Alba, a 38-year-old with HIV since 2003 and mother of four boys who do not have HIV, stands with two of her sons inside the Integral Attention Center of Escuela hospital in Tegucigalpa, Honduras. REUTERS/Edgard Garrido

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Women with HIV sterilised - sometimes unknowingly - though treatment can prevent mother-to-child transmission

MELBOURNE (Thomson Reuters Foundation) - HIV-positive women in Central America are being pressured to undergo sterilisation by prejudiced health workers and misled about the risk of the virus being transmitted to their unborn children, a study showed.

A survey of 285 women living with HIV in El Salvador, Honduras, Mexico and Nicaragua found that 23 percent of them had faced pressure from doctors and nurses to be sterilised.

The rate ranged from 20 percent in Nicaragua to 28 percent in Mexico, according to research by the Mesoamerican Coalition for the Reproductive Rights of Women with HIV and the Women and Health Initiative of Harvard School of Public Health.

The consistency of the rate over a large geographical area pointed to a "systematic pattern" of pressure and coercion, said Harvard School of Public Health research fellow Tamil Kendall.

"It's really unthinkable that women living with HIV are being pressured and forced into sterilisation when treatment almost eliminates the possibility of the mother-to-child transmission... and also provides options for safer conception and pregnancy," said Kendall, who presented the research at an international conference on AIDS in Melbourne on Wednesday.

"In this day and age there is no reason why women living with HIV can't safely exercise their reproductive rights," she told Thomson Reuters Foundation, adding that it was likely the attitude of many health workers reflected the stigma towards HIV in the societies they came from.


An estimated 17.7 million women worldwide had the human immunodeficiency virus (HIV) that causes AIDS in 2012, according to the World Health Organization (WHO).

Citing U.N. figures, Kendall said there were 59,300 women living with HIV in Mexico, El Salvador, Honduras and Nicaragua in 2012.

The study said pregnant HIV-positive women - whose status was known to health workers - were almost eight times more likely to report an experience of pressure or coercion to sterilise than women with HIV who were not pregnant.

In one "particularly horrific" case, Kendall said a Mexican woman was sterilised without her knowledge while under anaesthetic for a Caesarean section. When she woke up, her thumb had been dipped in ink so it could be used on a consent form.

In another case, a young Salvadoran said nurses threatened to deny her a Caesarean unless she signed up to be sterilised.

Health workers often fed women misinformation as a way of coercing them, said Kendall, who has carried out research on women living with HIV in Latin America for more than a decade.

"Women are told that if they have another pregnancy that either they will die or their children will almost surely acquire HIV and die," she said.

"Healthcare providers use these kinds of high pressure tactics to force them into sterilization, and this is simply scientifically untrue."

Without treatment, the likelihood of a HIV-positive mother transmitting HIV to her child during pregnancy, labour, delivery or through breastfeeding ranges from 15 percent to 45 percent, WHO says. With the right antiretroviral treatment, the transmission rate can be reduced to below 5 percent.

The women surveyed in Central America came from rich and poor, rural and urban backgrounds. Women of indigenous and African descent were also represented.

Yet neither their ethnicity, nor economic or social status were significant in indicating whether they were likely to be pressured to sterilise, Kendall said.

"That reinforces the idea that what is actually driving this is discrimination around HIV itself," she said.

(Editing by Alisa Tang:

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