There's an organization in Kenya that's paying HIV+ women $40 to have them put in an IUD - thoughts?

As long as the women are informed of the risks I am fine with it. I am not so much focused on HIV, but rather the women having birth control if they want it.

This will only reduce the likelihood of a baby getting HIV. It can makes Mom’s problems much worse (exposure to other STDs, exposure to a variant of HIV different from what she has, etc.). If the goal is to reduce vertical transmission, it may be efficacious, but could be disastrous for the mother (for $40). Not to mention that the article itself indicates the increased risk of pelvic infection/inflammation for the woman getting the IUD.

@Kayak8 How does it make the mom’s problem’s worse?

If men perceive that they can rape a woman without getting them pregnant, then they might be more apt to do so. Rape is a big problem in Kenya, with 1 in 20 women reporting it in their lifetime. Imagine how many go unreported.

@Kayak8 So you think if she doesn’t have the IUD she will have less sex or use condoms? Or, what are you thinking?

@jasonwiese55 Do you think the men there give a shit if the raped woman gets pregnant? What do you think they do check back to see if they made a baby? If anything those macho cultures think making a baby proves your a man. It is even true in America among the certain cultural groups. A percentage of the rapes there are of virgin girls because the men believe that will get rid of their own AIDS.

@jasonwiese55 How would they know? I mean, it’s not like you can tell a woman has an IUD unless she tells you. And I’ve found most rapists aren’t like “oh, better not rape that woman, she might get knocked up, and then I’d have to be a responsible father”.
Well, in the US, the commonly cited statistic is 1 in 6, and that was one study back in the 90s, so I’d imagine it’s quite a bit higher than ours.

@MyNewtBoobs @JLeslie Y’all are right.

I think it’s great that they want to help these women get long term birth control, but I agree with the article that paying them to do so could be basically bribing them to do so because many of them are poor. Once the women get the IUD and their money, they probably don’t have much incentive for the follow-up care they should be receiving. Considering many doctors are skeptical about giving IUDs to woman that have never had children, that have STDs, or that are not in monogamous relationships, it seems a little bit like a bad idea to just go around handing them out at will. The article mentioned the doctor screens the women to make sure they are really a match for getting an IUD, but I have to wonder how much their screening entails considering the risks involved with the IUD.

To me, it seems like this group wouldn’t really be upset/bothered if the women receiving the IUD became sterile since they really don’t want these woman having children anyway.

Financial incentives for repro control are always a no-no for me. Band aids.

@MyNewtBoobs and @JLeslie If a woman with HIV is given an IUD, it serves only to keep her from giving birth (to a baby with or without HIV). However, if a woman has an IUD, she will only be protected against pregnancy and NOT against other strains of HIV or against other STDs which can make complicate her own HIV progression. As IUDs can increase the risk for pelvic inflammation, bleeding etc., this can worsen her own health situation as well as pose an additional risk to sexual partners. I am most worried about the woman’s own health risk and an IUD does little to improve her health status and, in fact, could make it markedly worse.

Give her the $40 and let the women create incubator businesses without the IUD and I am on board. The $40 comes along with culturally relevant HIV prevention education and a visit with a primary health care practitioner and I am even happier.

@JLeslie I should add that with the IUD, I feel confident that condoms may fall by the wayside. This strategy is to reduce vertical transmission only. I get frustrated because so many times women with HIV are only viewed as a vector of disease transmission rather than as a patient in their own right. This has been a frequent refrain in the history of this epidemic.

@Kayak8 Yeah, I know, but these people are not using condoms period. It is some sort of fantasy in my opinion that not having birth control means they will use condoms for birth control. They still should use condoms for disease transmition even with the IUD, and they won’t, that’s the point. If they were using condoms we wouldn’t have to worry too much about vertical transmission, think about it.

@Simone_De_Beauvoir Would you care to elaborate as to why?

@Kayak8 I get that, but I think for Kenya, something is better than nothing.

@JLeslie and @MyNewtBoobs In many parts of the world, there are significant power inequities between men and women. In many of these locales, it is men (not women) who decide if condoms are to be used. This is true irrespective of the implantation of an IUD.

I don’t think Kenyan women have any less value than women in so-called first world locations and I don’t think “something is better than nothing.” The $40 could be much better spent without tying it to the woman’s reproductive capacity with the agenda of reducing transmission to infants at the risk of making the woman get sicker faster. This is a misguided solution to a problem at the expense of the woman. She is more than just a womb that COULD create HIV+ babies. She is a person with a serious disease and interventions designed to address HIV would be better directed at impacting cultural mores and norms that affect HER life, health and well-being rather than those that can make her health worse.

@Kayak8 I didn’t say that women there have less value. What I meant was, it seems like it’s either this, or people continue to go “wow, that really sucks, someone should do something” and then continue doing what they were doing. Ideally, there would be different kinds of birth control available to both men and women, at affordable prices, serious steps would be made to deal with the HIV issue, and rape wouldn’t be such an issue – but not having this organization won’t make that world any more of a reality. And I know that there are serious power inequalities, and men are the ones who decide if condoms are used, but I don’t know what that has to do with this. It just seems a little (maybe, if I’m understanding you correctly) like sacrificing an imperfect solution because it’s not idealistic enough.

@Kayak8 Of course it is the men that suck. Personally, I would much prefer an alternative birth control. I hope they are not using the IUD with hormones, because I know so many people who had a bad experience with it. In terms of PID and risk to fertility, ony the Dalkon Shield had really bad statisics, other IUD have been very safe.

I also dislike the idea that they are so poor they are partly pursuaded to do it for money. But, it seems to be around the world that the most prosperous civilized nations have some control over fertility. And, I am not judging a culture for living in a more primitive way, I do not equate poverty, or primitive with uncivilized at all. I have no prolem with people living off the land and having 10 children if they can care for them and live safe relatively healthy lives. Again, I am more focused on the birth control than the HIV, if the women want to control their fertility. I also know that there is little chance of HIV transmission if the mother is taking proper medication, but I am assuming the drugs are not easiy available or compliance is an issue.

I guess if they offered it for free it would sit better for me as I think about it. The money insentive casts a doubt in my mind about the intent of the project.

@Kayak8 And, I would love to change the cultural mores and norms. Hell, I want to do that with some of the subculture here in the US, right here in my backyard in Memphis TN. But, that is a slow long process that may never work.

@MyNewtBoobs and @JLeslie Could I just ask that you each read the entire article?

If IUDs were offered without an exchange of any sort and the full health consequences for women with HIV who live in their specific part(s) of Kenya were FULLY explained without coercion or money changing hands, and if it was explained that the IUD is solely for birth control and will not keep the woman safe from other STDs and variants of HIV that can make her get sick and die sooner—I am good with it. I want the women to have an informed choice rather than treating them like rabid dogs that might hurt someone else (baby).

The women should be screened for STDs before inserting the IUD (not happening in this scenario).

Use of IUDs can result in an inflammatory response in the endometrium and the resultant increase in lymphocytes and macrophages may provide targets for HIV replication. It is unclear what type of ongoing monitoring will be provided for the women who get IUDs (e.g., dealing with ectopic pregnancy, incidence of PID, concerns about anemia). The adverse events may not happen, but the women should know that they could.

I am also completely in favor of the incubator type businesses. This should not be in exchange for the IUDs. These are separate concepts.

I get that @JLeslie is focused on birth control. I am focused on the health of the women. These do not have to be mutually exclusive, but I don’t see how focusing on birth control at the potential expense of the health of the woman is in any way helpful.

@Kayak8 I agree, I don’t want birth control at the expense of the woman’s health. I want them to have informed consent. I also have decided I don’t want a financial incentive. But, I like the idea of this option to prevent pregnancy. I did not see in the article where it says the women are not evaluated for bacterial infection before inserting the IUD. Maybe I skimmed too fast.

Regarding the conversation about inflammation, STDs and other health concerns; what type of medical attention are the Kenyans who are HIV positive getting in the first place?

@Kayak8 I did, but I must be missing whatever it is you want me to see.

This type of medical intervention should only be used following strong evidence of benefit and lack of harm as demonstrated by multiple clinical trials (which has not happened). In addition, offering 10% of an average household annual income is coercive. Lack of required follow-up ensures poor data as well as unknown poor outcomes.

This would never be OK in the US… and is not OK anywhere else.

@MyNewtBoobs They feed into existing disparities without solving underlying issues.

Who cares about follow-up for an IUD! What kind of medical attention are they getting in the first place for the HIV!?