Monday, February 23, 2009

Reproductive Justice and HIV: They are Not Going Away

Dahlia Bell | SisterLove, Inc. MPH Intern
Dahlia Bell has been on the front lines of advocacy and activism for HIV/AIDS and the community well before relocating to the Atlanta area in early 2004. Originally from the state of New York, Dahlia was born in Poughkeepsie and raised in Middletown, about an hour from the heart of New York City. Dahlia graduated from Vassar College with a degree in Psychology and a Correlate Sequence in Africana Studies. She recently worked for AID Atlanta, Inc., providing comprehensive case management and educational services to women affected by, and living with, HIV/AIDS. She is currently contracted with The Children and Teenager's Foundation, Inc. to provide in-home behavioral counseling and therapy to at-risk youth and their families. Dahlia presently holds the position of Project Manager and Coordinator with Faith Christian Center, Inc. and Andre Butler Ministries headquartered in Atlanta. She is also pursuing her Masters of Public Health Degree from the Morehouse School of Medicine in Atlanta, Georgia, where she resides.
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When I agreed to blog for SisterLove, I was both excited and frustrated. I was excited because I would finally have a place to share information and express my thoughts and feelings about HIV/AIDS and women’s health — two topics I am very passionate about. I was frustrated because I knew that I had so much to say but didn’t know where to begin. How would I find my voice? If, or when I did, who would want to listen? Would my words make a difference? Despite my anxiety, my passion for these topics forced me to move beyond my fear.

After an interesting conversation with two guys, both about my age, I suddenly knew where to begin. I talked with them about my work with women living with, and affected by, HIV/AIDS. One of them asked a question that I often get whenever I tell people that I have worked in an AIDS clinic. He wanted to know if the women with whom I worked still had sex, got married, and had children. When I told them that my clients led normal lives that often included sexual relationships, marriage, and healthy children, they both seemed amazed. The one who had asked the question openly expressed his disgust at the thought of women with HIV/AIDS having sex with people who were not infected. My other friend was also disgusted. And then it happened. One of the guys said that he wished there was a way to force HIV-positive women to tell everyone about their HIV status so that people who were not infected could avoid them. Even though I have heard this before, I couldn’t believe that I was hearing it again. Hearing it again in 2009 when so much progress has been made since HIV first appeared on the scene 26 years ago. He actually suggested that women with HIV/AIDS didn’t have a right to keep their status confidential. As I said, I have heard such things before, mainly from those who are not infected, and mainly from men. It’s as if women with HIV/AIDS are no longer human beings, no longer capable of loving, no longer worthy of being loved. It’s as if they’re damaged goods who serve no place in society except as objects of public humiliation. Injustice always follows this type of ignorance.

Should women living with HIV/AIDS be allowed to maintain healthy sexual relationships (regardless of their partner’s HIV status), birth children, and have the right to control their reproduction? Just imagine a male legislator, or even a female one, feeling as my male friends. Such beliefs and prejudices could lead to legislation that forces people to reveal their HIV status or takes funding away from organizations that work with people with HIV/AIDS. We can’t afford to take this kind of ignorance and prejudice lightly. This type of blatant discrimination would seriously affect women who are already facing major health challenges and hinder organizations dedicated to serving them.

My conversation with the men led me to think more about women, HIV/AIDS, and reproductive rights. The rate of HIV and AIDS among women, particularly African American women, is rising steadily and does not seem to be slowing down. We have to accept that we can’t consider how AIDS affects women without also considering that AIDS is an issue of reproductive justice. The term, reproductive justice, is relatively new, having appeared in the past few years. It was coined by a group of Black female activists to acknowledge the many issues that are related to women ’s sexual and reproductive health and rights. It was important to these activists that we all understand and acknowledge that achieving reproductive justice must involve challenging racism, sexism, gender and ethnicity based health disparities, economic injustice, and human rights violations that affect the lives of women all over the world. In looking at reproductive justice it is obvious that HIV/AIDS is most definitely included.


Reproductive injustice, particularly in regard to women infected with, and affected by, HIV/AIDS, is not going away any time soon. To bring about positive change we need more opportunities to talk openly about the rights of women, especially as it pertains to their positive or negative HIV status. I am not angry with my friends for how they feel. I know that too many in our society already feel the same way and will continue to feel this way. I hope that the information I shared with my friends caused them to reconsider their attitudes and beliefs, and maybe even left them with a different impression of HIV-positive women. I hope they now understand that an AIDS diagnosis is not a mark of shame and that being diagnosed does not change your status as a human being. I hope that others in our society engage in similar conversations. I hope that those living with HIV/AIDS are no longer isolated and ostracized and feel safe to manage their diagnosis without fear of injustice. We can’t leave it up to organizations like SisterLove and AID Atlanta to shoulder the responsibility to change our world and fight for justice. We each have to do our part. Every conversation and every action contributes to change. The recent 2008 presidential election reminded us of the power one person can have to change a social condition. I took the time to educate my male friends. It didn’t seem like a big action at the time but now I see that it was a step, a positive step, toward the change that we need.

The Miseducation of HIV/AIDS and Breastfeeding: What is the Risk?


Ayanna Robinson | SisterLove, Inc. - MPH Intern
Ayanna Robinson was born and raised in Cincinnati, Ohio. She moved to Atlanta in 2003 to attend Spelman College. As a Biology major, she enjoyed learning about the different systems in the body, including the reproductive system. She combined her passion for biomedical research with her desire to serve her community and decided to attend Morehouse School of Medicine. At Morehouse School of Medicine, Ayanna is enrolled as a first year Master of Public Health (MPH) student with a concentration in Health Education and Health Promotion. A vegetarian for twelve years, her public health interests revolve around chronic disease and diet/nutrition. With an upbeat outlook on life, her motto is “All that we are is the result of what we have thought. The mind is everything. What we think is what we become.”


While I am open to embarking on all new, positive, and enlightening experiences, in this lifetime I can honestly say that I never imagined myself blogging for reproductive justice. And actually, before coming on board with SisterLove, I wasn’t exactly sure what reproductive justice was or even all the topics that it includes. So this will be an interesting journey. I will forewarn that as a mother of a beautiful baby girl, barely past her first year of life, and as a graduate student in the field of Public Health, 86% of my thoughts naturally turn to motherhood or school. It work likes this -- someone says “blog about reproductive justice”. I immediately think “breastfeeding”. Then from a public health stand point I think of promoting breastfeeding because of its benefits to mommies and babies. And because of my work with SisterLove I realize it is important to recognize the tie between “breastfeeding” and “HIV/AIDS”. And so, the plot, along with my mission, thickens.

Considering the many benefits of breastfeeding, I’ve always wondered why many minority women, especially African American women, opt not to breastfeed. With the proper information and a strong support network, I’m sure more women would choose to breastfeed. That’s my public health side coming out. But then I remember another group of women who, despite their personal preferences, would never get the chance to -- or have a reasonable option to -- breastfeed at all.

Until now, I never questioned or gave a second thought to the CDC, World Health Organization, and other medical experts’ advice that mothers living with HIV or AIDS should not breastfeed and should seek alternative/”safer” methods for feeding their babies. So for me and the rest of American society, women living with HIV and AIDS do not have the choice, or right, to breastfeed. Some recent studies, however, question the risk of mother to child transmission of HIV through nursing.

In many developing countries, infant formula is not readily available. Formula can’t be found ‘within the walking distance’ like it is in the U.S.. Or, better yet, formula isn’t affordable or culturally acceptable. And even when infant formula is available, it may not be a safe alternative because of the lack of water, or the lack of an uncontaminated water source. For these reasons there are many mothers with HIV and AIDS living in less industrialized nations who breastfeed their babies, despite medical warnings regarding HIV transmission. So the question remains, how risky is it for HIV-positive women to breastfeed?

Early research showed that breastfeeding increases the risk of mother-to-child transmission of HIV. The most often cited source for this conclusion, which is used to drive home the recommendation against breastfeeding for mothers with HIV or AIDS, is a study published by Dunn in 1992. However, in this study “breastfeeding” was not clearly defined. Other researchers have distinguished “exclusive breastfeeding” (defined as a diet consisting solely of breast milk) from a “mixed feedings” diet which is one that consists of breast milk and formula. Recent studies actually show that there is no additional risk of mother to child transmission of HIV if the baby is exclusively breastfed in comparison to not being breastfed at all (Coutsoudis et al, 1999). A study done in South Africa showed that by 6 months, babies who had been exclusively breastfed for 3 months still had lower rates of infection (18%) than never breastfed (19%) or mixed fed babies (26%) (Coutsoudis et al, 1999).

Some breastfeeding advocates now argue that exclusive breastfeeding should continue to be promoted for the first six months of life, despite the mothers’ HIV status. Breastfeeding gives the babies all necessary nutrients, builds a healthy immune system, and decreases the risk of developing certain disorders. But from a public health standpoint, prevention is definitely important when confronting HIV/AIDS and there is still a risk of transmitting HIV when breastfeeding. While I don’t believe that this newer research should cause HIV positive mothers to completely disregard warnings given by medical experts, I do believe that mothers should be properly educated on the risks and benefits of breastfeeding so that they can make the best decision for themselves and their babies. The inconsistencies in research, especially when it comes to clearly defining methods of “breastfeeding”, and the lack of available and accessible feeding options when alternative feeding methods are recommended, limit women’s right to make an informed choice.

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Sources:

Coutsoudis, et al, (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study, The Lancet 354: 471-6. See also correspondence in The Lancet 354: 1901–4.

Dunn, et al (1992) Risk of human immunodeficiency virus type 1 transmission through breastfeeding The Lancet 340: 585-8.

Pamela Morrison, IBCLC. Mothers and Babies and HIV: What is the Risk of Breastfeeding? AnotherLook. http://www.anotherlook.org/papers/e/index.php