HIV, Gender and Respectful Birth

Dismantling Stigma and Guaranteeing Rights in Perinatal Care

“When science moves forward but stigma remains, violence becomes invisible.”

Authors

• Dr Laura Abojer – Head of the Obstetrics.
• Dr Javier De Cicco – Obstetrician specialising in high-risk pregnancies and Head of Emergency Services.
• Nury Benavides, Lic. – On-call midwife and Coordinator of the Early Childhood Programme (PIM).

Institution
San Isidro Mother and Child Hospital. Buenos Aires, Argentina.

San Isidro, Buenos Aires, Argentina
December 2025

Abstract

Despite significant biomedical advances that have transformed HIV into a controllable chronic condition, many women and pregnant people still face discrimination in obstetric services. Birth, far from being a neutral space, often reproduces historical stigmas and prejudices around sexuality, motherhood and risk.

This article examines, from a gender and human rights perspective, how these forms of violence emerge in perinatal care, how they affect the emotional and clinical experience of women living with HIV, and which institutional and cultural transformations are needed to build a fully respectful and inclusive model of care.

1. Introduction: HIV, Inequality and the Challenge of Respectful Birth

HIV cannot be understood solely as a biomedical phenomenon. Its history is deeply intertwined with gender inequalities, poverty, sexual stigma and social exclusion. For many women, diagnosis means carrying moral assumptions about their private lives, their capacity to mother, and their responsibility for caring for others.

These narratives, which remain embedded in the collective imagination, seep into the birth scene and condition how professionals and health systems relate to women living with HIV.

In a context where respectful birth is recognised as a fundamental human right—linked to dignity, reproductive autonomy and non-discrimination—the persistence of HIV-related stigma becomes a serious obstacle to guaranteeing fair and humanised practices.

2. Stigma and Discrimination in Obstetric Care: A Violence with Many Faces

Much of the violence experienced by these women is neither spectacular nor explicit. It often appears subtly: in the tone of voice, in the absence of clear information, in clinical decisions imposed with no room for questions, in staff distancing themselves, in looks that convey mistrust or fear.

Obstetric violence, understood as the violation of autonomy, informed consent, privacy and dignified treatment, takes on specific features when the pregnant person is living with HIV. Constant suspicion, moral judgement, infantilisation and the imposition of rigid protocols become mechanisms of control that silence women’s voices and reduce their agency at a moment when respect for their bodily autonomy should be central.

These forms of discrimination do not arise in a vacuum. They draw on gendered prejudices that associate motherhood with purity, obedience and responsibility, and on the persistent notion that bodies living with HIV are inherently “dangerous” to others. Structural inequality compounds this reality, especially for young, poor and/or migrant women, who are more likely to receive punitive treatment within the health system.

3. Contemporary Biomedical Evidence vs. Outdated Clinical Practices

Scientific advances have radically transformed the perinatal landscape. With antiretroviral treatment and an undetectable viral load, the risk of vertical transmission of HIV is below 1%, and in these cases vaginal birth is completely safe. Caesarean section is recommended only when viral load is detectable or clinical follow-up has been insufficient.

However, these recommendations do not always translate into everyday practice. In many hospitals there is an overdramatization of risk leading to unnecessary interventions, arbitrary limitations on birth companions, unjustified separations of the newborn, and decisions presented as unquestionable even when they contradict current guidelines.

The gap between evidence and practice reveals more than a lack of updated training. It shows how stigma persists even when science no longer supports it. Discrimination is disguised as prudence, distrust hides behind “protocols”, and historical fear continues to shape actions that should be grounded in rights and knowledge, not in prejudice.

4. Breastfeeding as a Key Site of Symbolic Violence

Breastfeeding is one of the moments where symbolic violence becomes most visible. For decades, a blanket prohibition on breastfeeding was applied with no nuance, even though epidemiological contexts, access to antiretrovirals and mothers’ social conditions varied widely.

Many women report that this prohibition, communicated in a vertical and insensitive way, was experienced as deeply painful, as if their bodies were a danger to their child. Guilt and shame pile on top of the emotional strain of the postpartum period, creating experiences that leave lasting emotional scars.

Today, several countries are revisiting these policies. In contexts with sustained access to treatment and close clinical monitoring, the focus is shifting towards informed and supported breastfeeding, where women can make decisions based on their reality, their wishes and the recommendations of their care team.

What matters is not imposing a single practice but ensuring that information is clear, that mothers feel supported and that their autonomy is respected. Automatically prohibiting breastfeeding, without assessing each situation, constitutes a form of obstetric violence that violates fundamental reproductive rights.

5. Towards Respectful, Inclusive and Stigma-Free Care

Eradicating obstetric violence against women living with HIV requires transforming not only protocols but also institutional cultures and professional mindsets. Health-care teams need ongoing training that links biomedical evidence with gender perspective, ethics of care and human rights.

Risk assessment must move away from a punitive logic to become a shared tool: an analysis built with women, not about them. Practices should safeguard privacy, confidentiality, the presence of a chosen companion, shared decision-making, and respect for the timing and wishes of the pregnant person.

At the same time, institutions must commit explicitly to non-discrimination, creating work environments where stigma is identified, named and challenged. Observatories of good practice, restorative committees and participatory evaluation systems can be valuable tools to foster collective reflection, correct harmful dynamics and build more humane and just care models.

6. Conclusion: A Respectful Birth that Truly Includes All Women

When we speak of respectful birth, we refer to a right that allows no exceptions. Women and pregnant people living with HIV have historically faced a double judgement: that of the virus and that of morality. Eliminating obstetric violence in this context means dismantling prejudices, questioning inherited fears and returning to each woman the central role that is rightfully hers in the birth process.

It also means acknowledging that science no longer justifies many of the exclusionary practices of the past, and that a human rights–based ethic demands respectful, inclusive and dignity-based care.

A truly humanised obstetric model only exists when no one is left out. Guaranteeing respectful birth for women living with HIV is not an act of goodwill; it is a health and ethical obligation. Ultimately, it is a commitment to a society that values life, justice and equality from the very moment of birth.