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I begin by echoing what the center for health and gender Equity said that voluntary family planning and other reproductive health services are an important entry point to addressing HIV risk factors (including gender-based violence and sexual coercion), safe sex negotiation, voluntary counseling and testing, prevention of vertical transmission of HIV, and other prevention interventions. These services also reach women, youth, and men who would not seek out HIV services independent of other health services because of stigma or other barriers (2002–2012 Center for Health and Gender Equity). It is also agreeable that Voluntary family planning and other reproductive health programs empower women living with HIV to prevent health complications related to unintended pregnancies and to plan pregnancies based on their child-bearing desires and health needs.

The bottom line is- Linking HIV and reproductive health programs, like voluntary family planning and maternal health, improves access to both HIV and reproductive health services, reduces HIV-related stigma and discrimination, and extends programs to underserved populations (Ibid.2002-2012-report Tue 4 September2012.)

Kaiser Daily Global Health Policy Report; Wednesday, September 05, 2012 reported......

"Kenya has launched an investigation after researchers claimed HIV-positive women were being routinely sterilized without their consent in government hospitals," the Guardian reports. The African Gender and Media Initiative issued a report "based on interviews with 40 women, suggest[ing] the practice was widespread and ongoing," according to the newspaper. "The report also includes examples of coercive tactics used by medical staff to obtain consent -- for instance, threatening to withhold antiretroviral medication or baby milk if the woman did not agree to the procedure," the newspaper writes. "'These allegations are very serious and the Kenya Medical Practitioners and Dentists Board is going to investigate them before appropriate action is taken,' Shariff Shahnaz, the director of public health, told the Daily Nation newspaper," the Guardian reports (Mojtehedzadeh, 9/4).

However, as a woman, I was literally shocked at the results of study by the African Gender and Media Initiative based on interviews with 40 women in Kenya over what was claimed to be coerced sterilization without their consent(Sara Mojtehedzadeh in The guardian, Tuesday 4 September 2012).Surprisingly, the report suggested that the practice was widespread and ongoing. These shocking reports send Kenya (noted in the report by Kaiser.2012 above) to launch investigations after researchers claimed that HIV-positive women were being routinely sterilised without their consent in government hospitals. The report said some medical staff had coerced women into being sterilised by threatening to withhold antiretroviral drugs. Some woman who had sterilization in a mobile clinic run by Marie stops claimed there was no consent. This issue, as the report says is serious and has forced the government to start investigations into the matter(Ibid.2002-2012-report Tue 4 September2012.)

Pastoral concerns;
As I read through the report I pastorally encounter various realities for the women living with HIV in Kenyan communities;

o Exposure to threats in life; Women living with HIV, who underwent through the procedure as the report says, have had real challenges with their marriages. In African communities where I come from particularly the Kenyan communities, inability to bring forth a child is a serious cultural and community dilemma. This leaves the already vulnerable woman face the second and most crucial demand to bear children. In a nutshell, sterilization renders a married woman irrelevant since it is an expectation of the community that one has to have children soon after marrying, and continue to have. Culturally, it having children ensures continuity of family lineage, and heirs to families.

o Secondly; Stigmatization: labeling of the HIV positive women as people who bring problems to their communities pushes the women into social and cultural stigma which works negatively towards their health and general well being in families and communities.

o Thirdly, health care decision making; I find thinking on behalf of the HIV positive women and deciding what they should and should not be in the context of reproductive health infringing on their women and more so human rights. This further raises a lot of questions on the pertinent issue of respect and dignity of these women.

o Fourthly; HIV prevention, care, treatment and management: The threat to withhold ARVs belittles the international calls aimed to ensure universal access to health care by all people. It undermines the MDG’s call for more equitable, affordable, and comprehensive HIV services and as a platform to social justice which had inspired many people and communities everywhere to do better. It further waters down the high level meeting on AIDS and Beyond which established commitment of global community to vision of zero new HIV infections, Zero discrimination and zero AIDS related deaths(UNAIDS. 2011 Report).

o Injustice and abuse of rights ;All individuals—including those living with HIV—have the basic right to decide the number and spacing of their children and to have the information, education, and means to do so, free from discrimination, coercion, and violence. Access to voluntary family planning services ensures that women, youth and men living with HIV can exercise their right to the highest attainable standard of sexual and reproductive health, and allows for the management of family size and prevention of vertical transmission of HIV(UNAIDS. 2011 Report). This was not the case for the study’s 40 HIV positive women who were coerced to undergo sterilization since their right to choose which family planning method would work for them was seriously violated.

There is need to address the family planning issues that befell the HIV positive women by following the procedure and through all channels in Kenya. I am convinced that by addressing this important matter will help innocent women who may succumb into the hands of uncaring health practitioners who may only leave them with long term effects. Very importantly, there is also need to give the needed pastoral care and counsellling support to this group of women who face the new reality; never to have children in marriage, even when research has shown that HIV positive women are giving birth to bouncing babies who are HIV negative.

o Recommendations

 There is need to work on a systemic framework for integrating family planning and antiretroviral therapy services to women living with HIV.

 Implementation of guidelines on family planning that enhances the holistic health of the women living with HIV, her family and the community.

 Exercising the freedom of choice of the healthcare and family planning services by HIV women.

 Ensure Sensitivity at all levels and in all quarters to the social, psychological, spiritual, cultural, human, women needs and rights of all people irrespective of their health status.

Concluding remarks:
As a clinical pastoral therapist, I can only imagine the challenges the 40 women and many others who have not disclosed have gone through. I can imagine their aspirations and dreams of becoming mothers and wives one day in their lives. I can also imagine the potential they had, of raising sons and daughters and doing personal and community development. To some, all these have been shattered. They can never have children, and the number of children they wished for. To others, their dreams of marrying were cut short because of childlessness. And worse still, in the light of positive research that has increasingly shown that HIV positive women can have HIV negative children-those who were sterilized have their dreams of ever becoming a mother shattered. They can’t enjoy the fruits of this research because the procedure they had is irreversible.

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