BACKGROUND: Evidence suggests that women living with HIV (WLHIV) experience coercion by healthcare providers related to sterilization, contraception/family planning, pregnancy and feeding practices. However, there has been limited quantification of the prevalence and determinants of reproductive coercion among WLHIV.
METHODS: The People Living with HIV (PLHIV) Stigma Index 2.0 study was implemented in 16 countries in Eastern Europe and Central Asia(EECA) and Sub-Saharan Africa(SSA). Study implementation was led by networks of PLHIV(2020-2022). Interviewer-administered questionnaires were used to collect self-reported socio-behavioral measures among 10,555 cisgender 18+ year old WLHIV. Reproductive coercion in these analyses was categorized based on coercive experiences relating to recent (within last 12 months) sterilization; contraception/family planning; and pregnancy and feeding practices. Multilevel logistic regression models were used to assess hierarchical determinants of reproductive coercion.
RESULTS: Among participants in SSA, 0.5% reported sterilization, 1.6% reported coercion of contraception and family planning; and 4.8% reported coercion of pregnancy and feeding practices. Among participants in EECA, 3.2% reported sterilization, 3.9% reported coercion of contraception and family planning; 8.5% reported coercion of pregnancy and feeding practices. Women in EECA had an increased odds of sterilization, coercion related to contraception/family planning, and coercion related to pregnancy and feeding practices compared to women in SSA (Table 1). Across regions, sex workers, migrants, and women who inject drugs, and women with disabilities had greater odds of reproductive coercion compared to other WLHIV.
CONCLUSIONS: In 2022, recent reproductive coercion is common among WLHIV globally. Programs with trainings on accurate, evidence-based, and person-centered care for PLHIV, and non-stigmatizing care practices may improve healthcare provision of reproductive and sexual healthcare among WLHIV. Non-discrimination protections for WLHIV may support prevention of reproductive coercion and allow accountability when it occurs. Lastly, initiatives to support WLHIV in knowing their rights and how to seek justice may improve the health and wellbeing of WLHIV.