J HEALTH POPUL NUTR 2006 Dec; 24(4):413-425 ISSN 1606-0997 $ 5.00+0.20 © 2006 International Centre for Diarrhoeal Disease Research, Bangladesh Women, Reproductive Rights, and HIV/AIDS: Issues on Which Research and Interventions are Still Needed Maria de Bruyn ABSTRACT Policy Division, Ipas, PO Box 5027 Chapel Hill, NC 27514, USA From 2002 to 2005, two literature reviews identified a number of reproductive health issues that appeared to be relatively neglected in relation to HIV/AIDS: contraceptive information tailored to the needs of HIV-positive people; voluntary HIV counselling and testing during antenatal care, labour, and delivery; parenting options for HIV-positive people besides pregnancy through unprotected intercourse (i.e. assisted conception and legal adoption or foster care); unwanted pregnancy; and abortion-related care. An additional finding was that stigma and discrimination were frequently cited as barriers to enjoyment of reproductive rights by HIV-positive women. Subsequently, a pilot project was initi- ated in which non-governmental organizations (NGOs) in developing countries used benchmarks to ascertain whether these neglected issues were addressed in local programmes and interventions serving women affected by HIV and AIDS. The benchmarks also assessed whether policies and programmes paid attention to the human and reproductive rights of HIV-positive women. This paper describes the main findings from the two exercises in relation to contraception for women living with HIV or AIDS, abortion-related care, legal adoption by HIV-positive parents, and reproductive rights. It concludes with a number of recommendations on topics to be incorporated into the international research agenda, policies, and programmes in the field of HIV/AIDS. Key words: HIV; Acquired immunodeficiency syndrome; Women; Reproductive health; Pregnancy; Human rights; Contraception; Abortion; Abortion, Induced; Interventions; Research; Literature review INTRODUCTION United Nations (UN) agencies now speak about femi- nization of the HIV/AIDS pandemic because women comprise an increasing proportion of people affected by HIV and AIDS around the world (1). They include girls, women of reproductive age, and post-menopausal women, although most new infections occur in women of childbearing age. By December 2005, it was estimated that 40.3 million people were living with HIV world- wide; of these, 17.5 million were women. The percent- ages of women among HIV-positive adults aged 15-49 years range from 18% in East Asia to 57% in sub- Saharan Africa; in the latter region, young women aged Correspondence and reprint requests should be addressed to: M. de Bruyn Senior Policy Advisor PO Box 5027 Chapel Hill, NC 27514 USA Email: debruynm ipas.org Fax: 1-919-929-0528 15-24 years are at least three times more likely to be HIV-positive than their male peers (2). A number of factors make women more vulner- able to HIV infection. As is well-known, women are physiologically more susceptible to infection through acts of unprotected sex than men (1). In most socie- ties, large numbers of women are unable to insist on monogamy or consistent condom-use by their male partners due to gender-based imbalances in decision- making between the sexes. Where homosexuality is heavily stigmatized, considerable numbers of men who have sex with men and who marry women to conform to societal expectations do not reveal their homosexual activity to their female partners. This may be because they fear discrimination and violence if their homosexual encounters become known or because they feel that it is none of women’s business. In either case, they often do not broach use of condoms with their wives because it could cause suspicion or would prevent them from fathering children (3). Women who engage in sex work