Anonymous clinic protects rights of PLHIV

Denying reproductive health services to people living with HIV (PLHIV) or sero-discordant couples increases their vulnerability to sexually transmitted infections (STIs) and makes it harder for women to protect themselves against sexual violence and unwanted pregnancies.

According to Professor Praphan Phanuphak, director of the Thai Red Cross AIDS Research Centre in Bangkok and head of the Anonymous Clinic for couples living with HIV, "people living with HIV also have reproductive healthcare needs." Dr Praphan is widely acknowledged for his diagnosis of the first three AIDS cases in Thailand at Chulalongkorn Hospital in February 1985. For the past year, he has worked closely with Dr Surasith, Associate Professor of Obstetrics and Gynaecology at Chulalongkorn Medical School, to provide reproductive health services to PLHIV. Recently, a sero-discordant couple approached Dr Praphan for help. The husband, who was living with HIV, and his wife wanted to have children but they were worried about the stigma and discrimination they would face if they sought help from the public health-care system.
Dr Praphan provided antiretroviral drugs (ARVs) to the husband to minimise his viral load. Then, the couple had planned, unprotected sex and the wife was also provided with ARV therapy. She later conceived a healthy, HIV-negative child while also remaining free from the virus. "Medically it is not difficult at all to help HIV positive couples have children," Dr Praphan said. But many doctors working in hospitals are reluctant to provide reproductive health services to PLHIV. Before the Anonymous Clinic was set up in 1991, Dr Praphan organised a public forum on the rights of PLHIV to reproductive health care. Representatives from civil society, legal and medical experts and PLHIV all expressed the need for such a service, Dr Praphan said.
But a number of healthcare workers still rejected the idea that PLHIV should be provided with reproductive advice and care. "This belief has been internalised in Thai culture for a long time. Therefore, when we started this project it drew much opposition from the medical fraternity," Dr Praphan said. Now the clinic provides HIV and immunity testing, high-quality counselling and conducts drug trials. "We have made [the programme] a success and have garnered acceptance from within the academic and medical field," Dr Praphan said.

There is only one requirement of couples wanting to enrol in centre's assisted reproductive health programme. They must be assessed by social workers and two psychologists to ensure they are mentally and economically prepared for raising a child. They must also be able to bear the costs of the service. "If it is a case of an HIV positive wife and HIV negative husband, it is relatively easy. We can just put the male's sperm into a syringe and inject it into the woman," Dr Praphan said.

The woman would then receive therapy to prevent parent to child transmission of HIV. The risk of mother-to-child transmission in cases where the mother is given ARV treatment, has a safe delivery and practices safe infant-feeding techniques is less than two percent.

Men living with HIV who want to have children are required to undergo a sperm progressive motility process to remove the fluid around their sperm that could contain the HIV virus. Only HIV-negative sperm is artificially inseminated into their partners. Dr Praphan said that while there was a small risk of HIV transmission involved, it could be minimised by counselling and close clinical monitoring. The risk of transmission is higher among PLHIV who do not seek specialist help when trying to conceive a child. There are about 80 couples on the waiting list at Dr Praphan's clinic and about 40 couples are already receiving assistance. A number of women have safely become pregnant through the programme since it started a year ago.

Discrimination against PLHIV by health-care providers impedes efforts to meet their sexual and reproductive health needs. Many health providers assume that people with HIV do not have sex and fail to provide them with the information they need to prevent further transmission. Living with HIV is similar to living with other chronic diseases and PLHIV need a high degree of health and treatment literacy to help themselves stay healthy and lead normal lives. "PLHIV do not need to get ill and die," Dr Praphan said. "PLHIV can attain health." Health-care workers need to recognise the specific sexual and reproductive needs of PLHIV in order to help them protect their own health and the health of their families.

Bobby Ramakant-CNS