Source: The Guardian
Hundreds of pregnant women and girls are dying needlessly in South Africa, partly because of well-founded fears that their HIV status may be revealed during antenatal care, leading to discrimination in their communities and homes, according to Amnesty International.
In a report released on Thursday, Amnesty said that field research in the eastern provinces of Mpumalanga and KwaZulu-Natal showed women’s HIV status was sometimes revealed at antenatal clinics, with staff showing scant regard for patients’ right to confidentiality.
Something as simple as the queue women were asked to join could be enough to reveal a woman’s positive status, leaving her exposed to the stigma that persists around the virus that causes Aids.
More than a third of the 1,426 reported maternal deaths in 2012 were linked to HIV, the report said. Experts estimated that 60% of all the deaths were avoidable. A lack of information about sexual and reproductive health and poor roads also contributed to hundreds of maternal deaths by discouraging women from seeking adequate and timely antenatal care.
The report said that nearly a quarter of avoidable maternal deaths were linked to late or no access to antenatal care, which is free in South Africa’s public health system.
Amnesty’s secretary general, Salil Shetty, said: “It is unacceptable that pregnant women and girls are continuing to die in South Africa because they fear their HIV status will be revealed, or because of a lack of transport or basic health and sexuality education. This cannot continue.”
The report found that many women and girls do not attend clinics until the latter stages of pregnancy because they have been led to believe an HIV test is compulsory. In the report, some women who did attend clinics described how their HIV status could be revealed through negligence, inconsiderate processes and even workplace gossip.
“The nurses are talking about people and their status,” a woman from KwaZulu-Natal told the report’s authors.
In several clinics visited, the processing system identified pregnant women and girls living with HIV. Some used separate queues for antiretroviral medication, different-coloured antenatal files, and different days for appointments.
“[I]f I go for antiretroviral, my line is that side. All the people in this line, they know these people are HIV. That’s why people are afraid to come to the clinic,” a woman from Mpumalanga told Amnesty.
“During antenatal care, if women come out of the counsellor’s room with two files, then everyone knows they are HIV positive,” said another woman.
Women and girls told the report’s authors that they feared discrimination from partners and family members as a result of testing positive for HIV, and that stigma around the virus remained a problem in many communities.
Shetty said that HIV testing must be done in a manner that respects the rights of women and girls, without exposing them to additional harm.
She added that “it is vital that healthcare workers in South Africa receive additional training on providing quality care that is both free of judgment and stigma, and that women and girls accessing sexual and reproductive health services are able to trust that their confidentiality will be respected”. She called on the South African government to take urgent steps to ensure the privacy of pregnant women and girls is respected in health facilities.
In April, South Africa’s Human Sciences Research Council found that the prevalence of HIV and Aids in South Africa was rising, partly because the country has the world’s fastest growth rate in new infections and partly because patients were surviving longer, due to an expanded antiretroviral treatment programme.
The report said an estimated 12.2% of South Africa’s population was infected with the HIV virus in 2012, compared with 10.6% in 2008, based on a survey of 38,000 people. The percentage rise was partly due to the discovery of 400,000 new cases in the year studied, bringing the total number of infected people to 6.4 million, it said.
“The HIV incidence rates among women are of particular concern,” the report stated. It noted that the rate among females aged between 15-24 years was more than four times higher than for males in this age group. Overall, knowledge about how HIV is transmitted and can be prevented fell to 26.8% in 2012, compared with 30.3% in 2008.
In its study, Amnesty said many women, especially adolescents, lacked sufficient knowledge about sexual and reproductive health and rights, increasing the risk of unplanned pregnancies and HIV transmission. Women and girls were also often unaware of how important it is to have early antenatal checks.
Even if women do want to attend clinics, the state of the roads and the lack of reliable public transport can be obstacles. Amnesty said that some of the roads were so poor that they became impassable during the rainy season, with ambulances also refusing to go beyond a certain point on some roads.
The report’s authors called on the South African government to ensure that all health system procedures uphold patient privacy, particularly for people living with HIV. They also urged it to improve knowledge about sexual and reproductive health and rights, and urgently address the lack of safe, convenient and adequate transport.
“The South African government must ensure all departments work together to urgently address all the barriers that place the health of pregnant women and girls at risk,” Shetty added.