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Report says women in Chile with HIV face abuse and sterilization without consent.
SANTIAGO, Chile — Hours after Francisca gave birth to her first child, a midwife came into the recovery room and bluntly informed her that she would never have children again. She had been sterilized, unknowingly, during her cesarean delivery. Francisca was HIV-positive and only 21.
The young woman from Curico, a rural town in southern Chile, was diagnosed with HIV during routine exams early into her pregnancy in 2002. She immediately began treatment to avoid mother-to-child HIV transmission, but throughout her pregnancy no one in the local hospital counseled her on what it meant to be HIV-positive, the potential risks of transmission to her baby or the possibility of sterilization, claims Francisca, which is not her real name.
“As I was about to give birth, the nurse scolded me, telling me I was irresponsible for having gotten pregnant with HIV, and asking why I hadn’t aborted. It was horrible,” she said.
Even though Francisca went into labor before a programmed cesarean surgery, the doctor on shift that night nevertheless operated on her under general anesthesia. She woke up with a healthy, HIV-negative baby boy, and sterile.
Two NGOs brought her case to the Inter American Human Rights Commission in Washington. It is up to the court to decide whether the Chilean government failed to protect her from being forcibly sterilized.
There are about 3,500 women in Chile with HIV or AIDS, many of whom face widespread abuse in public health centers, discrimination and sterilization without consent, according to a report “Dignity Denied: Violations of the Rights of HIV-Positive Women in Chilean Health Facilities,” published last month by the New York-based Center for Reproductive Rights and the Chilean NGO Vivo Positivo.
“Sterilization without consent or under coercion occurs with enough frequency and throughout the country to be considered systematic,” said Suzannah Phillips, primary author of the report, which included interviews with 27 HIV-positive women in five regions of Chile. “It’s not an active government policy, but it is the result of government omission and not implementing its own guidelines."
Government health officials did not respond to repeated requests for interviews.
One-fourth of the women the center interviewed who had been sterilized said they had made a fully informed and voluntary decision. The rest said they experienced directive counseling, misleading or incomplete information and sterilization without their knowledge or consent during other procedures, especially during cesarean deliveries.
In 2000, the government issued guidelines establishing counseling and written informed consent prior to sterilization, but as Francisca’s case reveals, health professionals do not always stick to regulations.
“Today women with HIV can decide if they want a normal delivery or a cesarean, depending on their condition. But many women, especially in rural areas, don’t know that. Doctors tell them their babies will be HIV-positive if they don’t undergo a cesarean, and they won’t do the cesarean if the women don’t agree to sterilization. That’s how they scare women,” said Sara Araya, head of the women's department at Vivo Positivo.
Chile has taken major steps to address the HIV/AIDS epidemic. It adopted a national plan for the prevention, testing and treatment of HIV/AIDS that includes specialized multi-disciplinary teams in hospitals and universal access to antiretroviral treatment. Currently more than 80 percent of people with advanced HIV infection are receiving antiretrovirals.
But this has neither guaranteed quality health care nor halted discrimination against HIV-positive patients.
Such was the case of Matilde, a 36-year-old Peruvian immigrant in Santiago who tested positive for AIDS in 2003. (Matilde is not her real name. Neither Francisca nor Matilde wanted their names published because of the stigma associated with HIV.)