22 June 2011:

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) wishes to respond to issues raised in an article that appeared in The Daily News of June 21 2011, written by Malebogo Gaolebogwe, entitled Councillors Call for Regulation to Prevent Multiple Pregnancies where it is reported that among other things, the Ghanzi District Councillors reached a consensus to recommend for a policy to prevent HIV positive women from having multiple pregnancies.

Such comments are a reflection of the overwhelming lack of responsibility by men for their contributory role in HIV transmission. Falling pregnant is a result of an act between two consenting people and it can also be without consent. Punishing the one who carries the result of the act is tantamount to absconding from one’s responsibility in practicing safe sex and acknowledging the disadvantaged position of the ordinary woman.

In bringing clarity to this point, BONELA however wishes to make the following known:

  • One of the main components of the human rights approach is the gender discourse recognising “women’s deep political, social, economic, and sexual subordination, which is inscribed in law and enshrined in culture and practice. Discrimination, stigma, and violence are also daily realities for many women living with HIV and AIDS” . In view of this fact, it is a gross misjudgment to blame women alone for transmission of HIV in any circumstance.Women live in a society where they are subjected to various scenarios that lead them to becoming pregnant. We would thus err in putting all the blame on them. 
  • Pregnancy is oftentimes symptomatic of violence against women, a global epidemic that fuels high rates of HIV infection among women. Thus, women face a higher risk of HIV infection through forced sex than consensual sex. It is well known that “violence and the fear of violence can deter women from seeking HIV testing, insisting on condom use, or disclosing their HIV status to their sexual partners.” 
  • We commend the Government of Botswana for instituting the National ARV guidelines of 2008, recognizing that women have sexual and reproductive health rights and ensuring provision for women who are sexually active to receive counseling and proper guidance on family planning. This is in recognition of the fact that access to comprehensive sexual and reproductive health services for women and girls remains lacking and restricted by law and practice in every region of the world. 
  • This is because, they encounter blame and abuse when they are found out to be HIV-positive, deterring them from seeking HIV testing or treatment services. As recognized by the Open Institute of Southern Africa, “Women who become pregnant while living with HIV or AIDS often face judgment and recrimination by health care workers, rather than being offered proven treatment to prevent mother-to-child transmission of HIV.” The policy recommended by the Councillors will therefore only retract from this positive gain made by Botswana.
  • In addition, the Convention on the Elimination of All Forms of Discrimination Against Women and Children (CEDAW), which Botswana is party to, gives women the right to reproductive choices and requires states to ensure that women’s sexual and reproductive rights are realized.
  • The rights approach also encourages responsibility in light of exercising one’s rights. Therefore, everyone has the responsibility of practicing safe sex. BONELA thus seeks to condemn any suggestion that HIV positive women who are pregnant for the second time are fully responsible for spreading HIV. 
  • Failure to meet outcome results of the PMTCT programme cannot be blamed on the fact that someone is pregnant for the second or third time. The questions we should be asking ourselves are: why are women HIV positive in the first place? Why are they not been on treatment or adhering to it? What are the factors that pre-dispose them to HIV infection and “repeated” pregnancies; and how can these be addressed? How can men play a role in protecting women from HIV?
  • World over, it is now accepted that antiretroviral therapy (ART) is about 97% effective in preventing vertical transmission of HIV. If the women who were diagnosed with HIV are then put on treatment, there is a minimal chance that they will infect another person and used in conjunction with PMTCT, there is a negligible chance that the unborn child will be infected.
  • Lastly, for many women living with and vulnerable to HIV and AIDS, health systems remain places of prejudice and discrimination, rather than treatment and care. If the policy as advocated by the Ghanzi Councillors becomes reality, would just be another example. Therefore, we call upon these Councillors to desist from this and to exercise due diligence when they are making such comments because they are opinion leaders, and they should ensure that they do not fuel stigma and discrimination against people living with HIV/AIDS.