Pregnant Women Living with HIV/AIDS: - Center for Reproductive ...

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Pregnant Women Living with HIV/AIDSENDNOTES1 A note on terminology: The phrase “prevention ofmother-to-child transmission” is the one most commonlyused to refer to programs aimed at preventing HIVinfection in fetuses and newborns during pregnancy,childbirth or the postnatal period. This terminologyis increasingly being questioned by advocates whonote that it can imply that pregnant women andmothers living with HIV/AIDS are solely responsiblefor preventing transmission of HIV to their newborninfants. Alternative phrasing, including “preventionof parent-to-child transmission” has been advocated byseveral groups. See Human Rights Watch, A Testof Inequality: Discrimination Against WomenLiving with HIV in the Dominican Republic(2004), available at http://hrw.org/reports/2004/dr0704/ [hereinafter Human rights watch, A Testof Inequality]. Others have advocated for the term“perinatal” transmission. See Maria de Bruyn, Ipas,HIV/AIDS and Reproductive Health: Sensitive andNeglected Issues 29 (2005), available at http://www.ipas.org/publications/en/HIVLITREV_E05_en.pdf.Because this briefing paper focuses narrowly on therights of women in regimes commonly referred to bygovernments and the UN system as “prevention ofmother-to-child transmission” programs, this terminologyhas been used throughout.2 World Health Organization (WHO),Antiretroviral Drugs for Treating PregnantWomen and Preventing Infection in Infants:Guidelines on Care, Treatment and Support forWomen Living with HIV/AIDS and their Childrenin Resource-Constrained Settings 7 (2004),available at http://www.unaids.org [hereinafter WHO,Antiretroviral Drugs]. The guidelines state that“Over the past few years, considerable efforts have beenmade to introduce and expand programs to preventmother-to-child transmission of HIV.” Id. at iv.3 See Treatment Action Campaign et al v. Minister ofHealth et al, (South Africa, High Court, TransvaalProvincial Division, CCT 8/02, Case No. 21182/2001).In this case, access to PMTCT programs is recognized asan exercise of women’s right to health care. The courtopines that “The Constitution requires government todevise and implement within its available resourcesa comprehensive and coordinated program to realizeprogressively the rights of pregnant women and theirnewborn children to have access to health services tocombat MTCT of HIV.” Id. at 74.4 UNAIDS & WHO, AIDS Epidemic Update December2004 4 (2004), available at http://www.unaids.org/wad2004/report.html [hereinafter UNAIDS & WHO,AIDS Epidemic Update]; Human Rights Watch,Policy Paralysis: A Call for Action on HIV/AIDS-Related Human Rights Abuses Against Women andGirls in Africa 1 (2003), available at http://www.hrw.org/reports/2003/africa1203/ [hereinafter Human RightsWatch, Policy Paralysis].5 UNAIDS & WHO, AIDS Epidemic Update, supra note4, at 11.6 UNAIDS & WHO, AIDS Epidemic Update, supra note4, at 10, 12.7 Shelley Clark, Early Marriage and HIV Risks in Sub-Saharan Africa, 35(3) Studies in Family Planning 149(2004); Lawrence K. Altman, HIV Risk Greater for YoungAfrican Brides, N. Y. Times, Feb. 29, 2004, at § 1, 3.8 United Nations Development Fund for Women(UNIFEM), Turning the Tide: CEDAW and theGender Dimensions of the HIV/AIDS Pandemic 9(2001), available at http://www.unifem.org/resources/item_detail.php?ProductID=13; InternationalCommunity of Women Living with HIV/AIDS (ICW),ICW Vision Paper 4: HIV Positive Women andHuman Rights 4-5 (2004), available at http://www.icw.org/tiki-index.php?page=Publications.9 UNIFEM, supra note 8, at 10.10 See, e.g., Human Rights Watch, Just Die Quietly:Domestic Violence and Women’s Vulnerability toHIV in Uganda 38 (2003); see Suzanne Maman et al,the Horizons Project, HIV and Partner Violence:Implications for HIV Voluntary Counseling andTesting Programs in Dar es Salaam, Tanzania 15(2001), available at http://www.popcouncil.org/pdfs/horizons/vctviolence.pdf; UNIFEM, supra note 8, at10; Marge Berer, HIV/AIDS, Sexual and ReproductiveHealth at AIDS 2000, Durban, 8(16) ReproductiveHealth Matters 160-165 (2000).11 UNAIDS & WHO, AIDS Epidemic Update, supranote 4, at 1. The number of children living with HIV/AIDS is estimated to be in the range of 2.0-2.6 million.12 Id. at 14.13 Chewe Luo, Strategies for Prevention of Mother-to-Child Transmission of HIV, 8(16) ReproductiveHealth Matters 144 (2000).14 WHO, Antiretroviral Drugs, supra note 2, at 4.15 Valeriane Leroy et al., Maternal Plasma Viral Load,Zidovudine, and Mother-to-Child Transmission of HIV-1in Africa: DITRAME ANRS 049a Trial, 15 AIDS 517(2001).16 WHO, Antiretroviral Drugs, supra note 2, at 4.17 UNICEF, Mother-to-Child Transmission of HIV:A UNICEF Fact Sheet (2002) , available at http://www.unicef.org/publications/files/pub_factsheet_mtct_en.pdf.18 Luo, supra note 13, at 147.19 WHO, Antiretroviral Drugs, supra note 2, at 4, 5.20 Id. at 6.21 AVERT, Preventing Mother-to-Child Transmission ofHIV, at http://www.avert.org/motherchild.htm (lastvisited June 16, 2005).22 UNAIDS, Progress Report on the GlobalResponse to the HIV/AIDS Epidemic, 2003 at 64(2003), available at http://www.unaids.org/ungass/en/global/UNGASS_Report_2003_en.pdf [hereinafterUNAIDS, Progress Report].23 Id. at 65.24 UNAIDS & WHO, AIDS Epidemic Update, supranote 4, at 14.25 Office of the U.N. High Commissioner for Human14 August 2005
Protecting Human Rights in Programs to Prevent Mother-to-Child Transmission of HIVRights & Joint U.N. Programme on HIV/AIDS, HIV/AIDS and Human Rights International Guidelines(1998) para. 80 [hereinafter UN Human RightsGuidelines], available at http://www.unaids.org/html/pub/publications/irc-pub02/jc520-humanrights_en_pdf.htm.26 See Universal Declaration of Human Rights, adoptedDec. 10, 1948, art. 3, G.A. Res. 217A (III), at 71, U.N.Doc. A/810 (1948) [hereinafter Universal Declaration];International Covenant on Civil and Political Rights,G.A. Res. 2200A (XXI), U.N. GAOR, 21st Sess., Supp.No. 16, U.N. Doc A/6316 (1966), arts. 6(1), 9(1),999 U.N.T.S. 171 (entered into force Mar. 23, 1976)[hereinafter Civil and Political Rights Covenant];Convention on the Rights of the Child, adopted Nov.20, 1989, arts. 6(1), 6(20), G.A. Res. 44/25, annex, U.N.GAOR, 44th Sess., Supp. No. 49, at 166, UN Doc.A/44/49 (1989), reprinted in 28 I.L.M. 1448 (enteredinto force Sept. 2, 1990) [hereinafter Children’s RightsConvention]; Programme of Action of the InternationalConference on Population and Development, Cairo,Egypt, Sept. 5-13, 1994, paras. 7.3, 7.15, 8.34, U.N.Doc. A/CONF.171/13/Rev.1 (1995) [hereinafter ICPDProgramme of Action]; Beijing Declaration and thePlatform for Action, Fourth World Conference on Women,Beijing, China, Sept. 4-15, 1995, paras. 96, 106, 108,U.N. Doc. A/CONF.177/20 (1995) [hereinafter BeijingDeclaration and Platform for Action].27 Universal Declaration, supra note 26, art. 3; Civil andPolitical Rights Covenant, supra note 26, art. 9.28 See Civil and Political Rights Convenant, supra note26, art. 17(1); Children’s Rights Convention, supra note26, arts. 16(1), 16(2); ICPD Programme of Action, supranote 145, para. 7.45; Beijing Declaration and Platform forAction, supra note 26, paras. 106, 107.29 United Nations Committee on Economic, Social andCultural Rights, Gen. Comment No. 14, The Right tothe Highest Attainable Standard of Health, para. 9, U.N.Doc. E/C.12/2000/4 (2000), available at http://www.unhchr.ch/tbs/doc.nsf/(Symbol) 40d009901358b0e2c1256915005090be?Opendocument.“The Committee interprets the right to health, asdefined in article 12.1, as an inclusive right extendingnot only to timely and appropriate health care but also tothe underlying determinants of health, such as . . . accessto health-related education and information.” Id. para.11. It also states: “The obligation to fulfil (facilitate)requires States inter alia to take positive measures thatenable and assist individuals and communities to enjoythe right to health [including] . . . (iv) supporting peoplein making informed choices about their health.” Id.para. 37.30 Principles for the Protection of Persons with Mental Illnessand the Improvement of Mental Health Care, G.A. Res.199, U.N. GAOR, 46th Sess., Supp. No. 49 at Principle11, 2, U.N. Doc. A/RES/46/119 (1992) available at http://www.unhchr.ch/html/menu3/b/68.htm.31 Id.32 United Nations Committee on the Eliminationof Discrimination against Women, GeneralRecommendation No. 24, Women andHealth, Feb. 2, 1999, para. 20, available athttp://www.unhchr.ch/tbs/doc.nsf/(Symbol)/77bae3190a903f8d80256785005599ff?Opendocument33 UN Human Rights Guidelines, supra note 25, para.113.34 Id. (emphasis added). A 2004 UNAIDS/WHO jointpolicy statement supports mandatory HIV screening inblood that is destined for transfusion or for manufactureof blood products. In addition, mandatory screeningis required of donors prior to all procedures involvingtransfer of bodily fluids or body parts, including artificialinsemination and organ transplants. UNAIDS & WHO,UNAIDS/WHO Policy Statement on HIV Testing(2004), available at http://www.unaids.org/html/pub/unadocs/hivtestingpolicy_en_pdf.htm.35 Id.36 Maria de Bruyn, supra note 1, at 29.37 Health Canada, HIV Testing and Pregnancy:Medical and Legal Parameters of the PolicyDebate 84 (1999), available at http://www.aidslaw.ca/Maincontent/issues/testing/e-preg.pdf.38 Maria de Bruyn, supra note 1, at 29.39 Id. at 30.40 Health Canada, supra note 37, at 84.41 UNAIDS/WHO Policy Statement on HIV Testing,supra note 34 at 2.42 Id.43 Id.44 Principles for the Protection of Persons with Mental Illnessand the Improvement of Mental Health Care, G.A. Res.199, supra note 30.45 WHO, Antiretroviral Drugs, supra note 2 at 4, notingthat “The risk of MTCT can be reduced to below 2% byinterventions that include antiretroviral (ARV) prophylaxisgiven to women during pregnancy and labour andto the infant in the first weeks of life, obstetrical interventionsincluding elective caesarean delivery (prior to theonset of labour and membrane rupture) and completelyavoiding breastfeeding.” (citations omitted).46 Id. at 2; see also, Founding Affidavit of Treatment ActionCampaign, filed on 21 August 2001 at Pretoria HighCourt in the matter between Treatment Action Campaignet al. v. Minister of Health et al. at 12.47 Lawrence K. Altman, Infant Drugs For HIV Put Mothersat Risk, N.Y. Times, Feb. 10, 2004, at A22.48 WM El-Sadr et al., “The MTCT-Plus Initiative: ASuccessful Model Of Care and Treatment for HIV-Infected Families In Resource-Limited Countries,”Conference Posters International AIDS Conference,Bangkok 2004, available at http://www.mtctplus.org/pdf/MTCTPlus_Model_of_Care.pdf. MTCT-Plus programs,in contrast, aim to provide “lifelong care and treatmentto HIV seropositive pregnant and postpartum women,their partners, and their children.” Id.49 UNAIDS, Prevention of HIV Transmission fromwww.reproductiverights.org 15
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