An International Dilemma: Barriers to Sexual and Reproductive Rights

By Alexa Mieses

Picture taken from Nature.com

The New York Times reported today that a vaginal microbicidal gel has given women in one study a 39% chance of protection from the HIV virus. The microbicide contains a nucleotide reverse transcriptase inhibitor, which prevents the virus from reproducing. The study involved a double-blind, randomized controlled trial which compared tenofovir gel (the microbicide) with placebo gel in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural parts of South Africa. The study involved 30 months of follow-up with each of the women to assess their HIV serostatus, safety, sexual behavior, and gel and condom use. Read the original journal article here.

If such a microbicide is approved, to what extent will African women have access to the vaginal gel? One issue is cost. As the New York Times article mentions, each dose of gel is cheap, however, the patented applicators are rather expensive (forty cents each). Also, men have the authority in most African sexual relationships. While the microbicide may allow an African woman to decrease her chances of contracting HIV without the man's knowledge, will the fact that many physicians are male create a barrier to access of the gel? As of 2006, 70% of all physicians registered with the Health Professions Council of South Africa were male. Will a male dominated world serve as a barrier for African women to obtain the gel? I ask this question because in other countries like Chile and the United States, religious beliefs or political agendas, not whether one is male or female, has created barriers to certain reproductive rights.

The recent history of the emergency contraceptive pill in Chile is more of a flip-flop story of conflicting ideals. In 2006, first female and former Chilean president, Michelle Bachelet, began to more firmly advocate for women's contraceptive rights. By 2007, a presidential mandate made authorities ensure that public health centers made emergency contraception, or the morning-after pill, available. By 2008, courts ruled to only make the pill available in pharmacies and required a prescription. Read more here. Pharmacists would often refuse to sell the pill to women, even with a prescription, sometimes claiming the pill was "out of stock." In reality, religious beliefs instilled in many of the country's people (and pharmacists), often served as the basis for such behavior. Nearly 100 pharmacies were found failing to stock the pill altogether. In early 2010, at the end of her presidency, Bachelet once more was able to sign legislation that allowed the pill to be distributed freely throughout Chile. However, women in Santiago still report a stigma surrounding the purchase of the morning-after pill.

Africa and South America are not the only continents in which access to certain reproductive rights has been an issue. Abortion, while it is a very sensitive subject to some, has been the center of American media and political debate for some time. Since the Supreme Court ruling of Roe v. Wade in 1973, abortion has been legal. However, despite the fact that it is not illegal in many states, there are many barriers that sometimes make it impossible to have an abortion. While most restrictions regarding length of gestation are put in place for good reason, many states create certain restrictions which make it difficult for a woman to undergo an abortion. Also, women with little money or no health insurance often cannot pay for abortions. Additionally, in some places there is limited availability for medical training on abortion. The Association of Reproductive Health Professionals reported that although the Accreditation Council on Graduate Medical Education now requires that training in abortion be made available to all Ob/Gyn residents, as of 2008 only half of Ob/Gyn residency programs offer routine training in abortion care. Finally, violence and harassment of women seeking abortion and/or health care professionals that perform abortions, has created a barrier to the procedure.

As technology develops and new procedures and drugs are created, the political milieu of countries across the globe and women's rights also evolve. Regardless of the moral foundation upon which you stand, it is important to always remain well-informed of scientific developments to better take care of your health.

Flashblood: Part of the Cycle

By Alexa Mieses

Today I read a rather disturbing article in the New York Times. Recent reports indicate that in some parts of Africa, intravenous drug users are injecting other addicts' blood in order to get high. This practice has been coined "flashblood." The first thing that popped into my mind was the effect this practice has on the transmission of HIV. While the spread of HIV is dangerous and a serious matter, I could not help but wonder about the socio-econimic factors that may explain why one uses drugs in the first place.

Published in Addiction, a cross-sectional study was conducted in Tanzania with 169 female intravenous drug users. The study found that the women who used flashblood were more likely to live in short-term housing, to have been raped by a family member as a child, to have smoked marijuana at a younger age, and to have contaminated water.

Poverty often has many implications that stretch beyond contaminated drinking water. Poverty is an umbrella for a vicious cycle in which it is hard to determine which comes first. Does a child live in a broken home because he or she is impoverished, or is it difficult to rise out of poverty because he or she lives in a broken home? The answer is both are sometimes true. Perhaps a woman started using heroin because she smoked marijuana at a younger age. Perhaps she smoked marijuana at a younger age to numb the pain of her rape. Perhaps her father raped her because he was drunk. Perhaps her father was an alcoholic because he could not find a job. But why can't he find a job? You can see how the cycle continues.

Even here in Santiago, Chile, where I am spending my summer volunteering with VE Global (VE), the issue of poverty comes up every day. According to the CIA Chilean country-profile, the richest 10% of Chileans possess 41.7% of Chile's wealth, while the poorest 10% possess just 1.6%. The children with whom VE volunteers work often come from poverty and broken homes. Many have been sexually, physically and emotionally abused by their family members, or their families are unable to care for them due to a lack of resources. These children often go on to use drugs and have children at a very young age, thus proliferating the cycle. How can we break this vicious cycle? Even if the work of VE is not the "cure-all" answer, I believe it is a step in the right direction.

Image from www.maryscomfort.org