Should HIV-AIDS married women be tolerated to conceive?

INTRODUCTION

HIV disease is a continuum of progressive damage to the immune system from the time of infection to the manifestation of severe immunologic damage by opportunistic infections, neoplasm wasting, or low CD4 lymphocyte count, that define AIDS (Osmond 1998). The course of HIV and AIDS is particularly aggressive in children. Without HIV treatment and care, HIV multiplies and destroys the child’s defense to infection, leaving the child less able to resist pneumonia and other common childhood infections. However, a lack of necessary investment and resources including adequate testing, antiretroviral drugs and prevention programmes as well as stigma and discrimination mean children will continue to suffer the consequences of the epidemic (AVERT 2010). Only in high income countries HIV infection has virtually been eliminated given access to comprehensive Preventive Mother To Child Transmission (PMTCT) interventions. Every day about 1,000 children under the age of 15 become infected with HIV, and in 2007, UNAIDS estimated there were 2 million children living with HIV. The vast majority of these children either acquire HIV before they are born, during pregnancy or during delivery or when they are being breastfed (if their mother is HIV-positive) and about 50 per cent of children who acquire HIV from their mothers die before their second birthday. This must have alarmed the healthcare industry and the society.




STATEMENT OF THE PROBLEM

Should HIV-AIDS married women be tolerated to conceive?
Coerced sterilization of HIV positive women

GOAL:

To identify whether HIV-AIDS married women be tolerated to conceive.

OBJECTIVES:
a. To present the pros
b. To present the cons



CONS:

Philippines is a democratic country where every Filipino has the right to protect his human Rights, To protect human rights is to ensure that people receive some degree of decent, humane treatment (Maiese,2003). To violate the most basic human rights, on the other hand, is to deny individuals their fundamental moral entitlements. It is, in a sense, to treat them as if they are less than human and undeserving of respect and dignity issue. As seen in the population section of this web site, tackling many population related causes involves tackling many women’s issues such as increased knowledge and access to better health care, family planning and education for women. The beneficial results of these get passed along to the children and eventually the society. In fact, as PANOS shows in a report, providing women reproductive rights is part of their human rights. Even the international organization for women seconded this matter that providing women reproductive rights is part of their human rights (Women Reproductive Right, 2006). The law protects every individual within the country premises to be an advocate for himself like the right to conceive and thus not be coerced any act against his will. In addition, living in the centre of Christianity in Asia where morality, dignity, and the right to procreate are precedence, the law of church states that. Respect for that dignity is owed to every human being because each one carries in an indelible way his own dignity and value. The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born “must be the fruit of marriage”.
We also suggest that sterilization is not only an option for the HIV positive women. Here are some acceptable procedures for conception: Artificial insemination and in vitro fertilization. Timed, unprotected intercourse has not been shown to be safe and is not advised. To limit the risk of mother to child HIV transmission, anti-retroviral drugs may be administered to an HIV positive woman during the second and third trimesters of her pregnancy and to her baby during its first six weeks of life. In addition, planned cesearian section also reduces the risks. Couples should be advised too, that the absolute safest courses to consider are adoption or donor sperm.

William Keye, Jr., MD commented, "As care givers, we're responsible for ensuring the health and safety of our patients. With the development of new techniques and treatment protocols, we're able now to help HIV positive patients have children while minimizing the risks they face. I encourage clinics to develop the expertise needed to bring the hope of parenthood to these patients." (Ethics Committee of the American Society for Reproductive Medicine, 2002)

PRO
The percentages of women among HIV-positive adults aged 15-49 years range from 18% in East Asia to 57% in sub-Saharan Africa; in the latter region, young women aged 15-24 years are at least three times more likely to be HIV-positive than their male peers (Bruyn 2006). Chances of getting pregnant in the duration of HIV infection can happen if the woman has not yet undergone sterilization or has not considered nor applied any contraceptive method. It is as if the woman has condemned her child to death before being brought to life. In Namibia, healthcare providers recommend that HIV positive women should not have children after being infected. They believe that it is just to encourage sterilization to positive women who has a background of caesarian sections or miscarriages, status as single or widowed, unemployed, already has children, poor health, and/or complications with ARVs (ICW 2009). This is to protect the woman with her frail condition from complications during pregnancy, and the child inside her for future misfortunes. In Africa, where the most number of HIV positives are living, they have a surging of HIV and non HIV positive children who are orphans. These children witness their parents and other family members slowly die due to the disease. They see their loved ones suffer and perish. Both HIV and non HIV positive children also are forced to take care of their dying family member. Young children who are increasing in number, are strained to feed themselves and their family as well. A significant number of families who are inflicted with the virus are headed by a child these days.(childinfo 2009). In addition, there is still no law enacted to support abortion care to women living with HIV (IPAS 2008).

CONCLUSION

After weighing the pros and cons of the issue, the group has concluded that women diagnosed with HIV should not be tolerated to undergo pregnancy due to its detrimental effects to the female body and its foreseen damage to the possible offspring. HIV positive women don’t have the right to bear a child knowing that they are not capable of rearing in a way that children deserve. HIV positive women don’t have the right to conceive and risk transmission of the disease to the child. She doesn’t have the right to let this child suffer the complications of the disease, and the disturbing side effects of antiretroviral medications. HIV positive women don’t have the right to bear children just to have someone to take care of them in the moment that they can no longer take care of themselves. She doesn’t have the right to deprive a child from being a child. It is a violation to the child’s right, and an unforgivable act of irresponsibility. Therefore, the group agrees that coercive sterilization is an appropriate method to prevent pregnancy and its consequences.

From Group 2 (Abigail Santos): As health care professionals, we have our obligation and responsibility to preserve life not to end it (through abortion), to give our clients / patients the choice between the different interventions to preserve and maintain dignity over life not to decide for them ourselves. To the group, I get your point that HIV / AIDS is a curse. Yet you are not fulfilling your responsibility as a life preserver when you advocate abortion. Life needs not to be perfect, or in this case, normal or healthy, to blossom and exist. Life is not a privilege, but a right of every individual, even those yet to be born.

Upon reading your position in your topic our group still believes that a human being cannot be deprieved of her right to bear a child. There are so many ways in which a person can minimize the transmittal of HIV.Taking for example,the government specifically D.O.H can initiate programs with the objectives of decreasing the possibility of acquiring HIV and preventing the society of having a high rate HIV cases.

If Antiretroviral drugs will be shared to HIV positve mothers there are still many options of being pregnant.If you will prevent them to have a child you are getting their right to create their own family,right to give life to a child(even without seeking the advice of the doctor) and the right to live your life to the fullest.

I strongly agree on the 2 comments. Women should not be deprived of those things, first of all according to the bible, sex is made for couples bonded with love and their children will be the fruit of it. Those comes from God and we people should not be deprived of the beauty of God's gift. Some couples, where one of the partners is HIV positive, plan their pregnancies well in advance. Some choose to use fertility techniques such as artificial insemination, IVF, sperm washing or sperm donation to help reduce the risk of transmitting the infection. Nursing role is we can be the advocate, we can refer them to support groups and educate them of the care the mother will be getting from prenatal to post natal.

Thank you abby and rayhan.

to abby: our topic is about sterilization. we do not want our client to undergo abortion because there is still no law for safe abortion care(ICW 2008). Instead, before any instances of unwanted pregnancies or chances of mother to child transmission of the disease, we believe that sterilization of HIV positive women is the most beneficial method for the woman, the possible offspring, and the community.The Most Popular Method of Modern Contraception is sterilization (USAID 2005).

to rayhan:
Cost of Antiretoviral Treatment (ART) :US$ 10 000–12 000 per patient per year(WHO 2003)Obviously not applicable to women living in third world countries.Plus Side effects.

Women inflicted with HIV usually die within 10 years or 20 years maximum (HIVinSITE)In 2008, an estimate of 430,000 (240,000-610,000) children were born with HIV, bringing to 2.1 million (1.2 million–2.9 million) the total number of children under 15 living with HIV. Almost 90 per cent of these children live in sub-Saharan Africa. also in in the year 2008, sub-Saharan Africa accounted for 67 per cent of HIV infections worldwide, 68 per cent of new HIV infections among adults and 91 per cent of new HIV infections among children. The region also accounted for 72 per cent of the world’s AIDS-related deaths in 2008.

With this data, it is expected that these adults particularly women who are living with HIV will die. if these hiv positive women bear a child, who will then raise the child if the hiv positive mother's health has already deteriorated? could it be that these women conceive just to have someone to take care of them during their dying days? how can a mother decide to have a child just for the sake of fulfilling her essence as a woman-to bear a child- knowing that her child is at stake of suffering from disease complications, medication adverse effects, and living alone when the time comes that the HIV parent has to die?

I oppose the stand of the group. A woman has all the right to get pregnant. I believe this is the gift God has given to women-to conceive. Moreover, being positive with HIV is not a justification to take away that right. Nowadays, because of the technology and advance medicine a woman who is infected with HIV may be able to conceive provided that her body permits her to bear a child. As health care providers, we can give them information as to the pros and cons of pregnancy given the fact that they are afflicted with HIV. It is not our duty to dictate these people as to what to do with their lives.

Thank you arnie.

Yes it is in the bible that intercourse should be done out of love and the child is the fruit but im not sure if it is appropriate to use the bible as a reference.

intercourse is sacred. it is suppose to be an act of love but it also comes with a responsibility, and for our group, HIV women should be responsible enough to engage into such act sparing a child from being infected.

thanks heidi.

i agree with you that women have the right to conceive. HOwever, HIV positive women does not have the same option. A pregnant HIV positive woman is prone to miscarriages, and antenatal complication that most of the time result to abortion (who 2006). An HIV positive has a weak immune system. After 3 abortion procedures to a single woman, then it would the last of it. Why are we going to let this woman drown 3 times with sadness and grieving because of termination of pregnancy when we can prevent pregnancy in the first place? As healthcare providers we have the duty not only to the woman but also to the child to be born and to our society.

I,too, oppose to that stand. As health care professionals, it is one of our main responsibilities to educate the patients. Present to them the risks and the possible options. Imposing to them that they should not conceive is like instantly depriving them the right to decide for themselves.

I strongly disagree that a mother with HIV can't bear a child, well in fact according to the article that i've read there is a medication called "Nevirapine" given during labor used to prevent transmission of HIV to baby. As a result there is a marked decrease in the percentage of mothers testing positive for HIV under the Prevention of Parents to Child Transmission (PPTCT) programme at the Government General Hospital (GGH) as tested in India.

I would like to a agree with the group that it is hard to bring a child to the world knowing that they won't be able to take care of their children and give them the quality of life that they deserve. However I do believe that it is okay to be pregnant as long as necessary measures are taken to ensure that the child will be HIV free. Having the means is certainly a plus but given the situation of most Filipino, the lack of funding and support from the government is very minimal, this can be very difficult for the patients.

Thank you carlo..

The FDA has granted generic versions of nevirapine "tentative approval" status for purchase and use only as part of the President's Emergency Plan for AIDS Relief (PEPFAR) in resource-limited countries. Treatment guidelines of the U.S. Department of Health and Human Services designate nevirapine, in combination with zidovudine/lamivudine, as an "alternative" regimen for use in initial treatment of HIV infection. The guidelines designate nevirapine plus either zidovudine/lamivudine or tenofovir/emtricitabine as "regimens to be used with caution."(www.hivinsite.ucsf.edu). This drug may brought a number of adverse effects to the mother, thus to the possible offspring.

The government’s ABC plan may just work in lessening the cases of HIV in the country. The church may need to see the reason behind the use of condom. It is not to prevent form bearing children but to prevent the further spread of the disease. “B” be faithful is most helpful in stopping the spread of the virus but does it apply to the current times where sex is freely given to just about anyone.

I believe that the issue here is to sterilized HIV-AIDS women or not for the possibility that the child born out of those women will also have the same disease, besides when it comes to preventing the spread, limiting the sexual partner to one will give a higher chance of decreasing the spread of it.

In line with the drugs for HIV positive,we can purchase a generic drugs which is much cheaper. And to what your saying the Side effects(isn't our responsibility to alleviate the patients while undergoing medication with the supervisory of the doctor).So why not see it as an options and not depriving a woman to have a child which it is every persons right. As a nurse it is our role to refer them on the Institution for HIV and N.G.O.esp. to whose unfortunate HIV patients.

You have mentioned that HIV positive women don't have the right to bear a child. Does this mean we are depriving them of the right to have their own family? Isn't this a deprivation of someone else's happiness? What if the family appeals that they believe in God who is a miracle doer that He would grant them a child? Shall we persuade them that what they want is impossible based on statistics?

to rayhan: generic Antiretoviral drugs costs 2USD each and dosage varies. based on the minimum wage earned by a person who belongs to a third world country, two dollars is not cheap. the medication has side effects, the mother will still die because ARTs cant treat HIV/AIDS, a child will still be an orphan and worse, the child remains at risk of the disease and spreading the disease.

to tet: the abc's of the church has been proven to be ineffective based on the increasing number of illegal abortions, STDs.

It depends on how the person defines happiness. if a mother defines happiness as giving birth to a child that is anticipated to suffer,die, or be a witness to her painful dying experience, then that happiness should be re-spelled.

to ms. Carisa
Does the mother really have the right to choose death to her unborn child?
With us knowing that the unborn child is a different entity, and have a seperate life, as we all know human dignity should be respected from conception to death, therefore the mother have NO RIGHT to do SUCH THING
Thank you...

Even if the child faces early loss of their parents and more or less a shorter lifespan,allowing the child to live, you have respected the childs dignity as well as the child's opportunity to live and experience what life is.