Womens sexual and reproductive rights and HIV / AIDS.

A controversy exists in South Africa on whether to include or not include a reproductive rights clause in the new Constitution and Bill of Rights. Regardless of the outcome the issue of reproductive rights and clinical practice challenges both clients and health service providers. HIV serosurveillance of pregnant women was implemented in 1990. It has been indicated that prenatal patients have been tested without their consent or access to post-test counseling. This situation has resulted in discrimination against and inappropriate treatment of prenatal patients diagnosed with HIV infection. The inappropriate treatment stems from fear lack of knowledge or lack of resources. Most HIV-positive pregnant women do not opt for induced abortion. The chance of HIV being transmitted to the baby is 30%. Breast feeding increases the risk by 14%. Administration of AZT to the pregnant woman during pregnancy and labor and to the newborn for six weeks reduces the HIV vertical transmission rate to 8.3%. Low vitamin A levels have been associated with an increased risk of vertical transmission of HIV. Elective cesarean section may reduce transmission by 50%. Vaginal disinfection may also do so. HIV-positive mothers in developed countries are advised to bottle feed while those in developing countries are advised to breast feed. Could promotion of wet nursing satisfy infant needs as a culturally acceptable option in both rural and urban societies? Studies suggest that HIV-seropositive women suffer a higher rate of infertility than noninfected women. South Africa needs to struggle with the issue whether or not excluding HIV-positive women from infertility treatment abuses their constitutional rights. Should the decision revolve instead around the infertile womans CD4 count or clinical stage of the disease? Should HIV-positive fertile women be discouraged from having children and encouraged to be sterilized? Contraception issues in HIV-positive women must also be discussed. For example an increased risk of infection contraindicates the IUD among HIV-positive women so should it be avoided in these women? Should IUD insertion be preceded by an HIV test?