Many women living with HIV can have safe, healthy and satisfying sexual and reproductive health, but there is still a long way to go for this to be a reality, especially for the most vulnerable amongst them who face repeated Swaziland king select wife sexual dysfunction of their rights.
The contributions in this Supplement from researchers, clinicians, programme managers, policy makers, and women living with HIV demands an important appreciation that the field of sexual and reproductive health and human rights for women living with HIV is complex on many levels, and women living with HIV form a very diverse community. The manuscripts emphasize that attention must be paid to the following critical dimensions: An integrated approach to health and human rights lies at the heart of ensuring dignity and well-being of individuals around the world and is linked to improvements in the uptake of services and incidence of positive outcomes.
Through the roll out of antiretroviral treatment, advances in overcoming stigma and discrimination, and development of HIV prevention interventions, the HIV and AIDS response has given hope for a healthy life for many around the world.
However, for those who remain the most vulnerable, there is not nearly enough progress.
Women and girls, for instance, remain especially vulnerable to HIV infection because of a host of biological, social, cultural and economic reasons, including women's entrenched social and economic inequality within sexual relationships and marriage. HIV is not only driven by gender inequality, but it also entrenches gender inequality, leaving women more vulnerable to its impact [ 1 ].
Moreover, women and girls at risk of, or living with, HIV have additional challenges linked to sexual "Swaziland king select wife sexual dysfunction" reproductive health that includes risk of unintended pregnancy, complications arising from unsafe abortions and a host of other sexual and reproductive health morbidities.
In addition, women living with HIV are sometimes blamed for bringing HIV into the family and for being immoral and breaking sexual norms. Many women living with can achieve safe and satisfying sex lives, but there is still a long way to go for this to be a reality for the most vulnerable amongst them who face repeated violations of their rights.
For this special Supplement, we sought for seminal, peer-reviewed contributions that discussed varied perspectives and topics related to sexual and reproductive health and human rights of women living with HIV. These perspectives include contributions from researchers, clinicians, programme managers, policy makers and women living with HIV.
The latter perspective is important in allowing this Supplement to hear the voices of the women that we aim to support. The topics in this Supplement are equally varied from HIV pregnancy programming and sexual health to safer disclosure of HIV, mental health and violence, amongst others. This wide range of topics demands an appreciation of the fact that the field of sexual and reproductive health and human rights for women living with HIV is complex on many levels, and women living with HIV form a very diverse community.
The potential solutions regarding gender inequalities [ 2 ] and the challenges of ensuring human rights considerations as present in normative bodies [ 3 ], policies and programmes [ 4 ] reflect two cross-cutting issues, gender equality and human rights, that permeate the whole Supplement and form the foundation for strengthened services that meet the needs of women living with HIV. The papers on sexual health for women living with HIV were Swaziland king select wife sexual dysfunction positioned before those on reproductive health, given that sexual health and the right to a safe and satisfying sex life [ 5 ] is a topic often not addressed by clinicians despite its vital importance, at a personal level for women, especially in an era of over-criminalization of HIV.
Whether in resource-constrained or wealthier settings, women living with HIV should be offered choices and health interventions that would allow them to lead healthier lives. This is true, for instance, of cervical which is a disease that is preventable, but for which screening and prevention in low-income countries [ 6 ] remains a challenge.
The next set of papers are about women's mental health, gender-based violence and disclosure — three of the most core topics of importance to, and experienced by, women living with HIV, issues that are under-addressed and under-recognized, but fundamentally affect the experiences of women living with HIV in their most intimate lives.
The first two papers are critical as they were led by women living with HIV giving the first-person's voice to the experience of mental health and violence, and both arose from the largest global survey of women living with HIV on sexual and reproductive health and rights priorities [ 9 — 11 ].
Building capacity for the community to be better heard within an academic context and further strengthening research to address gaps in our knowledge remain two critical priorities in order to build evidence-based guidance and recommendations.
The systematic review of disclosure in the context of fear of violence [ 12 ] and the review of the needs of adolescent girls living with HIV [ 13 ] remind us that much remains to be achieved in the post era. The past 20 years have seen tremendous progress in the area of sexual and reproductive health and rights. The number of births to adolescents has also declined worldwide [ 14 ]. However, evidence shows the slow and uneven progress in various areas related to women and health, such as nutrition, sexual and reproductive health, HIV and Swaziland king select wife sexual dysfunction sexually transmitted infections and violence against women.
Poor sexual and reproductive health outcomes represent one-third of the total global burden of disease for women between the ages of 15 and 49 years, with unsafe sex a major risk factor for death and disability among women and girls in low- and middle-income countries. In addition, worldwide, inmillion women were estimated to have an unmet need for modern contraception. When we look at the situation of women living with HIV in relation to sexual and reproductive health, the scenario remains bleak.
In low-income countries,
Swaziland king select wife sexual dysfunction is often linked to HIV infection and is among the leading causes of death of women of reproductive age and those aged 20—59 years.
Persistent obstacles in health systems to realizing the aims of the international declarations and conventions, including a lack of gender responsiveness with regard to sex-disaggregated data and gender analysis, result in health services that do not take into account the specific needs and determinants of women's health.
Women, especially those living with HIV, continue to have inequitable access to good-quality health care services in many countries. Pockets of low health system coverage exist globally, and services in many rural areas and urban slums are often of low quality.
Women living with HIV are confronted with multiple and intersecting forms of discrimination, which additionally contributes to the lack of good health services. Poor health service coverage is exacerbated by HIV status and gender-related barriers to access to prevention, treatment and care.
The papers in the Supplement aim to ensure that the sexual and reproductive health and human rights of women and girls living with HIV are addressed, with due attention accorded to the following critical dimensions:.
This Supplement includes contributions from a broad range of stakeholders on the complexity of issues related to sexual and reproductive health and human rights of women living with HIV. To realize this vision, the international development agenda in this regard should emphasize providing an enabling environment for women living with HIV to receive services that are based on principles of human rights and gender equality.
Emphasis should also be placed on investing in integrated programmes interlinked with the different health-enhancing sectors, including, but not limited to, education and nutrition. We acknowledge the women living with HIV and health care advocates around the globe who have inspired this work for a stigma-free world. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.
The authors have no conflicts of interest and have not received any funding related to this work. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. There are several pathways by which Swaziland king select wife sexual dysfunction inequalities shape the sexual and reproductive health and wellbeing of women living with HIV.
First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their Swaziland king select wife sexual dysfunction fertility preferences and disclose their HIV status.
Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences.
This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma
Swaziland king select wife sexual dysfunction discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care.
Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences.
Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Globally, women constitute half of all persons living with HIV.
In low- and middle-income countries, female sex workers are Globally, transgender women are 49 times more likely to be living with HIV as compared to all adults of reproductive age groups [ 2 — 4 ].
The sexual and reproductive health needs of women living with HIV require particular attention because these women are disproportionately vulnerable to certain reproductive health problems as compared to HIV-negative women and also in relation to the prevention of vertical transmission of HIV. Swaziland king select wife sexual dysfunction show that, as with women who are HIV negative, women living with HIV have high rates of unintended pregnancy and low rates of contraceptive use including condom use [ 5 — 9 ].
In sub-Saharan Africa, women living with HIV are significantly more likely to die during pregnancy or the postpartum period as compared to HIV-negative women [ 1011 ]. Globally, women living with HIV are also more likely to have a higher incidence and progression of cervical neoplasia as compared to women who are HIV negative [ 12 ]. There has been increasing attention given to certain aspects of reproductive health of women living with HIV, particularly in the context of preventing vertical transmission of HIV.
There has been less attention to a more holistic response that goes beyond disease prevention and addresses the sexual, emotional and mental health as well as social and economic wellbeing of women living with HIV as a legitimate focus of programming and research in its own right [ 1617 ].
This state of affairs stands in stark contrast to what
Swaziland king select wife sexual dysfunction living with HIV have articulated as their needs and priorities. These needs include the importance of addressing gender inequalities, violence against women, financial security and social support, reproductive health beyond pregnancy, and sexuality in a positive framework [ 18 ].
The report identifies stigma and discrimination, gender inequalities, and punitive laws and policies as three of the top four reasons for their Swaziland king select wife sexual dysfunction. Nearly two decades of research and programming have highlighted that gender inequalities are a key structural driver of women's vulnerability to acquiring HIV. The importance of addressing gender inequalities is well recognized in key global commitments to ending HIV.
However, concrete actions on
Swaziland king select wife sexual dysfunction significant scale and in a sustained manner with concomitant resources are yet to materialize. The pathways by which gender inequalities shape women's risk of acquiring HIV are increasingly being mapped out, particularly as they relate to the intersections of intimate partner violence and HIV [ 21 — 23 ]. There is a small, but increasing body of evidence on interventions that work to address gender inequalities as a structural driver of women's risk of becoming infected with HIV, such as those that promote egalitarian gender norms, empower women and girls economically and in their sexual and reproductive decision-making, and reduce violence against women [ 23 — 27 ].
While gender inequalities affect HIV-negative women as well as women living with HIV in many similar ways, the latter face unique challenges related to stigma and discrimination, as well as pressures related to their sexual and childbearing decisions, economic security, mental health and emotional wellbeing.
This paper describes how gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV, specifically via the following pathways: These pathways are examined in terms of four interrelated outcomes: The concept of wellbeing is included to underscore the importance of considering mental and emotional health as well as social and economic factors.
In many settings, gender norms privilege men's control over women or perpetuate unequal power relations.