Southern Africa: HIV pregnancy, stigma and ignorance

JOHANNESBURG, 26 January 2009 (PlusNews) – For many women, pregnancy is a time of anticipation and celebration, but for those living positively it can be frustrating when their status – and not their pregnancy – takes centre stage. Being pregnant and positive often comes with its own brand of stigma.

In a study among HIV-positive women in the United States, released at the international AIDS conference in Mexico in 2008, about half the respondents thought HIV-positive women could have children if they received appropriate care.

But roughly the same number said they felt society strongly discouraged them from doing so, revealing what researchers said was a dichotomy between the women’s views about their bodies and society’s.

Tough choices

Emma Tuahepa was the first woman in Namibia to go public about her HIV-positive status. She is also the proud mother of a healthy, HIV-negative 6-year-old girl. She noted that seven years after prevention of mother-to-child transmission services were introduced in the country, HIV-positive expectant mothers are still stigmatised.

“Being HIV-positive, you are seen as irresponsible in getting pregnant, in not looking at your own health. The fact that there is some possibility of mother-to-child transmission makes you a problem as an HIV-positive woman, because you are seen as adding to an existing problem,” she said.

“My child could be orphaned because I die of HIV, but tomorrow [parents who are HIV-negative] could die in an accident and that child would also become an orphan,” she pointed out.

Prejudice ultimately drove Tuahepa to take drastic measures. After being artificially inseminated in South Africa – a prevention technique not available in Namibia – she decided to stay there for the duration of her pregnancy and only returned to Namibia almost a year later.

“The fact that it’s your first pregnancy, and that you opt to go where there is not even your family, or people who can support you; that you leave everything behind – that is a sign of how strong stigma and discrimination are.”

Tough critics

In South Africa there are almost 300,000 pregnancies per year involving HIV-positive mums-to-be, according to the latest antenatal survey in 2007. With numbers like these, it might be surprising that Fikile Mabuza* thought she would be the only HIV-positive pregnant woman at the clinic.

This is because of misconceptions about HIV and pregnancy. “Some people don’t have information and they talk out of the blue, just to talk,” she said. “Sometimes I feel like I could punch them because they talk and they don’t know – they just criticise HIV. Yes, HIV … has killed people, but it’s manageable.”

Mabuza eventually lost her baby in the seventh month of her pregnancy, but said she and her fiancée – who is HIV-negative – plan to try again in 2010.

Hard realities?

Seven years ago, Priscilla Khauoe found herself in the same situation and what she learned then as an HIV-positive pregnant woman propelled her into activism. She now works as a testing counsellor for Persevere until Something Happens (PUSH), an HIV/AIDS organisation in Johannesburg, South Africa.

Khauoe said she still sees the same negative attitudes about positive motherhood as she did when she was pregnant with her son. “If I am in a relationship and I tell a person I’m HIV-positive, the first thing the person says is: ‘What happens when we get married? What are we going to do? I want children.'” she said.

“It’s like people think, ‘How can she be pregnant when she knows she is HIV-positive?’ She said stigma still has a lot to do with how HIV is perceived and misunderstood.

“We think that when you have HIV, you are sick and you are dying,” she said. “A person thinks that they can’t have a baby because the baby will be sick; it will die. They think life has stopped because they are HIV-positive.”

Rakgadi Mohlahlane, programme manager at the Centre for the Study of AIDS and a researcher investigating stigma, warned that it was a complex issue. “Stigma happens for a variety of reasons, and it’s not based in any reality – it’s based on people’s perceptions,” she told IRIN/PlusNews.

“Those perceptions started from an attempt to moralise the whole HIV epidemic, and because of those perceptions some people feel – on a ‘moral ground’ – that a woman who behaves a certain way deserves to have HIV, or doesn’t deserve to have a child.”

Nomfundo Eland, national programme manager for women’s rights at Treatment Action Campaign (TAC), an AIDS lobby group, admitted that pregnant women living with the virus were still treated unfairly. “Basically, people think HIV-positive women shouldn’t be having unsafe sex, which is why they are pregnant.”

The organisation works with women to “try to explain about issues of reproductive rights and that, in most cases, pregnancies should be about planning,” said Eland.

“We also talk about options, but many of those options – like artificial insemination – aren’t available to most women because they are very expensive. People need to be aware that women who are HIV-positive are also women, and have to enjoy their reproductive rights.”