414 J Health Popul Nutr Dec 2006 due to poverty frequently feel unable to demand use of condoms by clients. Marginalized women, such as female injecting drug users, girls, and women living on the streets who engage in transactional sex, are also often in this position. Women are much more frequently victimized than men in domestic violence and sexual assaults in all countries of the world (4), placing them at direct risk of HIV infection and unwanted pregnancies as a result of rape. Actual and threatened psychological and physical violence also plays a role in their being unable to use contraceptives, including condoms. Poverty and lack of property rights can prevent women from leaving marriages characterized by domestic and sexual violence (5-6). These situations, which increase the vulnerability of girls and women to HIV and sexually transmitted infections (STIs), violence, and unwanted pregnancies, clearly indicate that high priority must be given to meeting the reproductive health needs of women. This is particularly the case for women living with HIV since their problems may be exacerbated. For example, it appears that women who disclose their HIV status may risk violence from their partners, families, or social environment (7). To assess whether attention is indeed being paid to the broader reproductive health needs of women af- fected by HIV and AIDS, literature reviews were car- ried out to identify which reproductive health issues appear to be relatively neglected in relation to HIV/ AIDS. The reviews showed that these issues included: 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 concep- tion and legal adoption or foster care); unwanted preg- nancy; and abortion-related care. An additional finding that emerged from the reviews was that stigma and dis- crimination were frequently cited as barriers to enjoy- ment of reproductive rights by HIV-positive women. Subsequently, a pilot project was initiated in which non-governmental organizations (NGOs) in develop- ing countries used benchmarks to ascertain whether a number of the neglected issues identified in the literature reviews were addressed in local programmes and inter- ventions serving affected women. The benchmarks also included attention paid to the human and reproductive rights of HIV-positive women. This paper describes main findings of the two exer- cises in relation to contraception for women living with HIV and AIDS, unwanted pregnancy and abortion-re- Bruyn M lated care, legal adoption by HIV-positive parents, and reproductive rights. It concludes with a number of reco- mmendations on topics to be incorporated into the inter- national research agenda, policies, and programmes in the field of HIV/AIDS. MATERIALS AND METHODS Literature reviews In 2002, an initial literature review focused on factors that may influence decisions of HIV-positive women about childbearing, pregnancy outcomes in relation to HIV/AIDS, prevention of perinatal HIV transmission (PPT), and pregnancy termination by women living with HIV (8). An updated review, completed in January 2005, added some topics that seemed to be largely ab- sent in the literature read for the first review: provision of contraceptive information tailored to the needs of HIV-positive women, critical and sensitive aspects of HIV counselling and testing during antenatal care and labour before childbirth, options for parenting other than pregnancy through unprotected intercourse, and abor- tion-related care (9). The literature reviews covered more than 350 docu- ments produced mostly after 1997. Searches were done in the CINAHL, MEDLINE, POPLINE, SOCIOFILE, and PSYCHINFO databases (key words: HIV, unwant- ed pregnancy, miscarriage, and abortion) and through Internet search engines (key words: contraception, con- traceptives, pregnancy, PMCT or PMTCT, perinatal transmission, miscarriage, abortion, adoption, and fos- ter care). Abstracts and materials collected at the XIII, XIV and XV International Conferences on AIDS were further included. The documents read included research reports, sci- entific journal articles, conference abstracts and posters, policy and training manuals and guidelines, course ma- terials, informational and educational materials, newspa- per articles, and communications disseminated through e-mail forums. The studies were not assessed regarding the methodologies used or their research strengths and weaknesses; the aim was simply to determine whether they addressed the topics chosen and, if so, what findings or recommendations they presented. Pilot project in developing countries In 2004, as follow-up to the literature reviews, Ipas col- laborated with the International Community of Women Living with HIV/AIDS (ICW), the Center for Health and Gender Equity, and the Pacific Institute for Wom- en’s Health to publish a simple monitoring tool that NGOs and community-based organizations (CBOs)