HIV prevention and testing strategies for women
By Sonia Rastogi
In the U.S., there is a social norm that non-injection-drug using women and women not identified as sex workers are at low to no risk for HIV. This norm manifests itself in: 1) women being discouraged or outright denied HIV testing, 2) HIV further stigmatized as a disease for people who engage in “risky behaviors” and 3) decreased provider comfort and competency to talk about HIV and STIs when providing sexual and reproductive health services to women. These factors perpetuate women’s belief that they are at low risk for acquiring HIV. Hence, the past 10 years have seen a steep rise in the number of women infected with HIV through heterosexual sex. The likelihood of HIV acquisition is embedded under layers of racism, classism, sexism, and violence that cause women of color, particularly African-American women, to be the most affected.
For women, HIV education, awareness, and testing cannot stand by itself – it must be integrated into sexual and reproductive health services to have a greater impact because women of all ages are far more likely to seek out services for family planning, birth control, and fertility than HIV services and primary care. The example that immediately comes to mind is annual OB/GYN exams. During this routine exam, emphasis is placed on current and future reproductive ability. Birth control and family planning options are easier to discuss. Counseling and prescriptions to go on the pill or get an IUD are commonplace. However, it is not as common for providers to perform a risk assessment for sexual health, including screening for intimate partner violence, HIV, and other STIs. This gap perpetuates a decreased and inaccurate perception of HIV risk for women of child-bearing age. Clearly, if family planning and birth control are being discussed, there is a need to explore risk and discuss solutions to prevent HIV and STI transmission. By having non-judgmental HIV screening and comprehensive education available at the same time, existing health efforts would capture a demographic that may otherwise be missed.
In addition, although with proper care and support mother-to-child transmission can be effectively prevented in the U.S., HIV-positive women report extremely low rates of pregnancy counseling; demonstrating that reproductive health services have not been well-integrated into HIV services and indicating that reproductive options for HIV-positive women may not be well-accepted or understood among HIV service providers and OB/GYNs.
A couple of key steps to service integration include provider sensitivity and competence training, and capacity-building to provide services. Provider training is important since many providers feel uncomfortable talking about sexual health, prevention, and risk reduction methods with clients. Capacity building to ensure services are easily accessible by providers and consumers is important, especially for patients who are not in routine care. Accessibility for providers includes clinical and technical support in health care settings to aid providers in linking patients to services. Accessibility for consumers includes affordability, ease of transportation, and competent care. For more information, check out the UN Population Fund & International Planned Parenthood Foundation 2004 report on Integrating Voluntary HIV Counseling and Testing Into Reproductive Care and PAHO’s 2010 report on Linking Sexual and Reproductive Health and Gender Programs and Services with Prevention of HIV/STI.
By integrating both the HIV/STI conversation and routine HIV testing into sexual and reproductive health services, education and awareness about HIV will increase and more women will get tested. To have the greatest impact on women’s health, integration of sexual and reproductive health, and HIV services must happen in both testing and care settings: primary care clinics, public health centers, correctional facilities, HIV/STI testing sites, HIV care sites, and during pre/neo/ante-natal care. Over time, this integration process can provide a client-centered and comprehensive approach to sexual and reproductive health care as HIV testing and care for HIV-positive clients becomes routinized, destigmatized, and normalized.
Bio:
Sonia Rastogi coordinates the HIV and Hepatitis testing program at Asian and Pacific Islander Wellness Center in San Francisco. Sonia is passionate about upholding human rights and improving the health status of women through community development and public policy. In addition, Sonia performs with Rhodessa Jones’ The Medea Project, a theatre company designed to spark social change by narrating stories on women and HIV.