Reproductive rights and HIV/AIDS

Reproductive and sexual rights are at the centre of the acquired immunodeficiency syndrome (AIDS) epidemic through culturally defined gender roles, gender-based violence and limited access to quality health care. AIDS control is one of the Millennium Goals, and the ‘3-by-5’ initiative [antiretroviral (ARV) therapy for all in need by 2005] is far from reaching its target. Apart from the reduction in morbidity and mortality due to antiretroviral (ARV) therapy, proven effective interventions for reproductive health include consistent condom use, voluntary counselling and testing, promoting earlier treatment and adhesion to preventative measures, and the use of ARV therapy, Caesarean section and bottle-feeding to reduce vertical transmission. The effectiveness of control of sexually transmitted infection is dependent on the maturity of the AIDS epidemic, but is an essential intervention due to other serious consequences for sexual and reproductive health. Male circumcision is a polemic preventive measure under debate, and microbicide products, a promising women-controlled method, are still undergoing efficacy trials. A reasonably organized and accessible health sector, the involvement of males in reproductive health debate and a gender-sensitive, rights-based political agenda, with ample participation of communities, are necessary for reproductive health interventions to move from proved efficacy to necessary effectiveness, putting evidence into practice.