The reproductive needs and rights of people living with HIV in Argentina: health service users' and providers' perspectives.

This article focuses on the contraceptive and reproductive experiences and needs of people living with HIV and on public health services' responses to them in Argentina. Data collected through a national survey amongst people living with HIV (N=841) and semi-structured interviews (N=89) explored the perspectives of both health-care users and HIV/AIDS program coordinators and providers. The survey revealed that 55% of women and 30% of men had had children after their HIV diagnosis and that half of those pregnancies had been unintended. At the time of the survey in 2006, 73% of men and 64% of women did not want a (new) pregnancy. The vast majority report systematic condom use, but acknowledge difficulties complying with this recommendation. Dual protection (i.e., condom use plus another method) is low among those who do not want children or another pregnancy (8% of women and 9% of men reported using it). Mostly women and heterosexual men without children either expressed their wish or were seeking to be parents. Institutional and cultural barriers to friendly and/or effective contraceptive and reproductive counselling were identified. Most physicians encourage only condom use while a minority refers patients to family planning providers or talk with them about contraception. A lack of updated information about interactions between antiretroviral drugs and hormonal contraception and/or intrauterine devices was not infrequent among providers. Users reported having being discouraged or blamed by health professionals when they revealed they wanted to have (or were expecting) a baby. Professionals and program directors' attitudes regarding reproduction range from not acknowledging people's wishes, to providing useful information or referral. Whether wanted or unexpected, parenthood is a challenge for many of the people living with HIV. Social and biomedical responses still need to be refined in order to fully respect people's rights and succeed in preventing (re)infection as well as unwanted pregnancies. Drawing on study results, recommendations to enhance the provision of adequate information and services to help people prevent unwanted pregnancies or reproduce as safely as possible are discussed.

The experience of stigma: people living with HIV/AIDS and Hepatitis C in Argentina / La experiencia del estigma: las personas que viven con VIH/SIDA y Hepatitis C en Argentina

This article compares the experiences of people living with HIV/AIDS with those living with Hepatitis C in Buenos Aires, Argentina. In both cases, people learn to live with the illness, and get to know about symptoms, treatments, diagnoses, and future perspectives. In the end they become "experts" on the matter. At the same time, they are forced to deal with the "synergy of stigmas" associated with deadly diseases, and in most cases related to sexual behaviors and lifestyles historically stigmatized. Selected by availability we interviewed 27 people living either with HIV, Hepatitis C, or both; and 20 health care professionals. Through out this paper we trace similarities, differences, and articulations in terms of the management of the information on homosexual identity, being drug users, and living with HIV/AIDS and Hepatitis C. We analyzed these issues as non-evident traits of discreditable individuals, which allow a relative concealment and their fears on revealing their secrets.

Este artículo compara las experiencias de personas que viven con VIH/SIDA con las de personas con Hepatitis C en Buenos Aires, Argentina. En ambos casos, las personas aprenden a vivir con la enfermedad y a conocer sobre síntomas, tratamiento, diagnósticos y perspectivas futuras. Al final se convierten en "pacientes expertos" en la materia. Al mismo tiempo son forzados a manejar la "sinergia de estigmas" asociadas con enfermedades letales, en la mayoría de los casos relacionados a conductas y estilos de vida históricamente estigmatizados. Seleccionados por disponibilidad, entrevistamos 27 personas que viven con VIH, con Hepatitis C o con ambas, y a 20 profesionales de la salud. A través de todo el trabajo trazamos similitudes, diferencias y articulaciones en el manejo de la información sobre la identidad sexual, el uso de drogas y la vivencia con el VIH/SIDA y la Hepatitis C. Analizamos estas cuestiones como rasgos no-evidentes de individuos desacreditables, lo que permite una relativa simulación, y los temores que dichos individuos albergan sobre la revelación de sus secretos.