許多感染愛滋病毒的婦女報告了強制生殖保健做法

非洲、東歐和中亞的人權受到威脅

資料來源：巴基塔·卡薩達 / 2023 年 7 月 26 日 / aidsmap

Carrie Lyons 博士在 2023 年 IAS 上。攝影：Roger Pebody。

    在撒哈拉以南非洲、東歐和中亞地區，感染愛滋病毒的婦女面臨醫療保健專業人員強制生殖脅迫的風險增加。性工作者、吸毒婦女和愛滋病毒呈陽性的移民更有可能接受不合格且帶有侮辱性的生殖照護。約翰霍普金斯大學公共衛生學院的 Carrie Lyons 博士在澳大利亞布里斯班舉行的第十二屆國際愛滋病協會愛滋病毒科學會議 (IAS 2023) 上報告了這一結果。

    數據收集自愛滋病毒感染者污名指數 2.0，該指數由全球愛滋病毒感染者網絡 (GNP+)、國際愛滋病毒感染者婦女協會 (ICW)、國際計畫生育聯合會 (IPPF)和聯合國愛滋病規劃署（UNAIDS）共同開發。污名指數是一種國際標準化工具，使愛滋病毒感染者能夠自我報告他們所經歷的污名和歧視。研究小組研究了這些數據，重點關注被診斷感染愛滋病毒至少一年的順性別女性的情況。數據收集於 2021 年至 2022 年之間。團隊針對干擾變量進行了調整。

    脅迫是指在未經個人自由和知情同意的情況下向個人施加壓力，要求其進行生殖介入。該團隊尋找與計畫生育或懷孕有關的強制做法的經歷，特別是強制或脅迫絕育的經歷。

    本研究涵蓋的 11 個撒哈拉以南非洲國家為安哥拉、貝寧、布吉納法索、科特迪瓦、加納、肯亞、毛里塔尼亞、尼日、賴索托、多哥和辛巴威 (n=10,719)。東歐和中亞五國是白俄羅斯、哈薩克斯坦、吉爾吉斯斯坦、俄羅斯和烏克蘭（n=2,075）。

參與者被問及前一年的生殖脅迫情況。一般來說，侵犯生殖權利在這兩個地區都很常見：

•撒哈拉以南非洲、東歐和中亞分別有 1% 和 3% 的人經歷過強制絕育。

•在撒哈拉以南非洲、東歐和中亞，分別有 2% 和 4% 的人經歷過強迫計畫生育。

•在撒哈拉以南非洲、東歐和中亞，分別有 5% 和 10% 的人經歷過與懷孕相關的脅迫。

感染愛滋病毒的女性亞群體面臨著特殊的風險。在撒哈拉以南非洲，吸毒婦女和移徙工人不成比例地經歷了醫療保健專業人員的強迫性家庭計畫、懷孕和絕育。具體而言，移民和吸毒婦女遭受強迫絕育的可能性分別高出七倍和三倍。

在東歐和中亞，性工作者和吸毒婦女遭受醫療保健專業人員強制避孕的風險增加（分別是 1.5 倍和 1.77 倍）。此外，年輕女性遭受與懷孕相關的強迫的風險增加（1.75倍）。

團隊根據單一身份對數據進行分析；萊昂斯博士表示，交叉分析可能會進一步強調多重身份如何加劇女性的脆弱性。萊昂斯博士強調，迫切需要解決各種環境下的強制問題，以提高醫療品質。生育脅迫會使個人愛滋病毒治療結果惡化，並威脅到更廣泛的愛滋病毒應對措施。感染愛滋病毒的婦女面臨的結構性暴力，特別是在愛滋病毒定罪的背景下，對獲得醫療保健和生活品質產生影響。該小組呼籲對感染愛滋病毒的婦女提供非歧視保護，以防止醫療保健專業人員進行生殖脅迫，並在發生這種情況時追究責任。

參考文獻：

Lyons C et al.  撒哈拉以南非洲、東歐和中亞感染愛滋病毒的婦女遭受生殖脅迫的經歷。 第 12 屆 IAS HIV 科學會議，布里斯班，摘要 OAC0405，2023。

Coercive reproductive healthcare practices reported by many women living with HIV

Human rights threatened in Africa, eastern Europe and central Asia

Bakita Kasadha / 26 July 2023 / aidsmap

Dr Carrie Lyons at IAS 2023. Photo by Roger Pebody.

Women with HIV are at an increased risk of reproductive coercion by healthcare professionals across sub-Saharan Africa, eastern Europe and central Asia. Sex workers, women who use drugs and migrants who are also HIV positive are more likely to receive sub-standard and stigmatising reproductive care. This was reported by Dr Carrie Lyons from the Johns Hopkins School of Public Health at the 12th International AIDS Society Conference on HIV Science (IAS 2023) in Brisbane, Australia.

The data were gathered from the People Living with HIV Stigma Index 2.0, which was developed by the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV (ICW), the International Planned Parenthood Federation (IPPF) and the United Nations Programme on HIV/AIDS (UNAIDS). The Stigma Index is an international standardised tool enabling people with HIV to self-report the stigma and discrimination they experience. The team looked at these data, focusing on the accounts of cisgender women who had been diagnosed with HIV for at least one year. Data were collected between 2021 and 2022. The team adjusted for confounding variables.

Coercion relates to pressuring individuals to have reproductive interventions without their free and informed consent. The team looked for experiences of coercive practices in relation to family planning or pregnancy, and especially for experiences of forced or coerced sterilisation.

The 11 sub-Saharan African countries included in this study were Angola, Benin, Burkina Faso, Cote D’Ivoire, Ghana, Kenya, Mauritania, Nigeria, Lesotho, Togo and Zimbabwe (n=10,719). The five eastern Europe and central Asian countries were Belarus, Kazakhstan, Kyrgyzstan, Russia and Ukraine (n=2075).

Participants were asked about reproductive coericion in the previous year. Generally, violation of reproductive rights was common across both regions:

• 1% and 3% experienced forced sterilisation in sub-Saharan Africa and eastern Europe and central Asia respectively.
• 2% and 4% experienced coerced family planning in sub-Saharan Africa and eastern Europe and central Asia respectively.
• 5% and 10% experienced coercion related to pregnancy in sub-Saharan Africa and eastern Europe and central Asia respectively.

There were particular risks for sub-groups of women with HIV. In sub-Saharan Africa, women who use drugs and migrant workers disproportionately experienced coerced family planning, pregnancy and sterilisation from healthcare professionals. Specifically, migrants and women who use drugs were seven times and three times more likely to experience coerced sterilisation respectively.

In eastern Europe and central Asia, sex workers and women who use drugs were at increased risk of coercion related to contraception by healthcare professionals (1.5 and 1.77 times respectively). Moreover, young women were at increased risk for coercion related to pregnancy (1.75 times).

The team analysed the data according to single identities; Dr Lyons stated that an intersectional analysis would likely further highlight how multiple identities compound women’s vulnerabilities. Dr Lyons stressed the urgent need to address coercion across various settings to improve healthcare quality. Reproductive coercion worsens individual HIV treatment outcomes and threatens the wider HIV response. The structural violence that women with HIV face, especially within the context of HIV criminalisation, has implications for access to health care and quality of life. The team call for non-discrimination protections for women living with HIV to prevent reproductive coercion by healthcare professionals and allow accountability when it occurs.

References

Lyons C et al. Experiences of reproductive coercion among women living with HIV in sub-Saharan Africa, eastern Europe and Central Asia. 12th IAS Conference on HIV Science, Brisbane, abstract OAC0405, 2023.