Kendall Tamil, Albert Claire
Women and Health Initiative, Department of Global Health and Population, Harvard School of Public Health Boston, MA, USA;
Women and Health Initiative, Department of Global Health and Population, Harvard School of Public Health Boston, MA, USA.
J Int AIDS Soc. 2015 Mar 24;18(1):19462. doi: 10.7448/IAS.18.1.19462. eCollection 2015.
Forced and coerced sterilization is an internationally recognized human rights violation reported by women living with HIV (WLHIV) around the globe. Forced sterilization occurs when a person is sterilized without her knowledge or informed consent. Coerced sterilization occurs when misinformation, intimidation tactics, financial incentives or access to health services or employment are used to compel individuals to accept the procedure.
Drawing on community-based research with 285 WLHIV from four Latin American countries (El Salvador, Honduras, Mexico and Nicaragua), we conduct thematic qualitative analysis of reports of how and when healthcare providers pressured women to sterilize and multivariate logistic regression to assess whether social and economic characteristics and fertility history were associated with pressure to sterilize.
A quarter (23%) of the participant WLHIV experienced pressure to sterilize post-diagnosis. WLHIV who had a pregnancy during which they (and their healthcare providers) knew their HIV diagnosis were almost six times more likely to experience coercive or forced sterilization than WLHIV who did not have a pregnancy with a known diagnosis (OR 5.66 CI 95% 2.35-13.58 p≤0.001). WLHIV reported that healthcare providers told them that living with HIV annulled their right to choose the number and spacing of their children and their contraceptive method, employed misinformation about the consequences of a subsequent pregnancy for women's and children's health, and denied medical services needed to prevent vertical (mother-to-child) HIV transmission to coerce women into accepting sterilization. Forced sterilization was practiced during caesarean delivery.
The experiences of WLHIV indicate that HIV-related stigma and discrimination by healthcare providers is a primary driver of coercive and forced sterilization. WLHIV are particularly vulnerable when seeking maternal health services. Health worker training on HIV and reproductive rights, improving counselling on HIV and sexual and reproductive health for WLHIV, providing State mechanisms to investigate and sanction coercive and forced sterilization, and strengthening civil society to increase WLHIV's capacity to resist coercion to sterilize can contribute to preventing coercive and forced sterilization. Improved access to judicial and non-judicial mechanisms to procure justice for women who have experienced reproductive rights violations is also needed.
强制绝育是一种国际公认的侵犯人权行为，全球感染艾滋病毒的女性（WLHIV）都有相关报告。强制绝育是指一个人在不知情或未获得知情同意的情况下被绝育。胁迫绝育是指利用错误信息、恐吓手段、经济激励措施或获取医疗服务或就业的机会来迫使个人接受绝育手术。
基于对来自四个拉丁美洲国家（萨尔瓦多、洪都拉斯、墨西哥和尼加拉瓜）的285名感染艾滋病毒的女性进行的社区研究，我们对关于医疗保健提供者如何以及何时向女性施压进行绝育的报告进行了主题定性分析，并进行了多变量逻辑回归分析，以评估社会经济特征和生育史是否与绝育压力相关。
四分之一（23%）的参与研究的感染艾滋病毒的女性在确诊后经历了绝育压力。在怀孕期间（及其医疗保健提供者）知晓其艾滋病毒诊断的感染艾滋病毒的女性，比在怀孕时不知晓诊断的感染艾滋病毒的女性经历强制或胁迫绝育的可能性几乎高六倍（比值比5.66，95%置信区间2.35 - 13.58，p≤0.001）。感染艾滋病毒的女性报告称，医疗保健提供者告诉她们，感染艾滋病毒使她们失去了选择子女数量和生育间隔以及避孕方法的权利，就后续怀孕对妇女和儿童健康的后果提供错误信息，并拒绝提供预防艾滋病毒垂直（母婴）传播所需的医疗服务，以迫使女性接受绝育。在剖宫产时实施了强制绝育。
感染艾滋病毒的女性的经历表明医疗保健提供者的艾滋病毒相关耻辱感和歧视是强制和胁迫绝育的主要驱动因素。感染艾滋病毒的女性在寻求孕产妇保健服务时特别脆弱。对卫生工作者进行艾滋病毒和生殖权利培训，改善对感染艾滋病毒的女性的艾滋病毒及性与生殖健康咨询，提供国家调查和制裁强制和胁迫绝育的机制，以及加强民间社会以提高感染艾滋病毒的女性抵抗绝育胁迫的能力，有助于预防强制和胁迫绝育。还需要改善司法和非司法机制，为经历过生殖权利侵犯的妇女伸张正义。
