South African delegate to Aids 2104 conference tells of bitterness at forced procedure and struggle for rights

This article is more than 6 years old

This article is more than 6 years old

When Sthembiso Mthembu was just 22, she was forcibly sterilised.

The South African human rights activist, now 39, had gone to hospital extremely unwell. Doctors diagnosed her with a cervical cyst needing immediate surgery. But they refused to operate unless she also agreed to undergo sterilisation, because she had HIV.

“I knew what my rights were, and I knew I was being violated, but I was very sick, and I needed help,” she said.

“So I resigned myself to it, knowing it was completely unjust. When you need assistance, and you need it now… I couldn’t use my rights because I needed help. So I had to bargain with my rights.”

Mthembu says she will never get over what happened.

“It never ends,” she said. “I think about it every day. It impacts every single point of your life. You have a birthday. You start a new relationship. You hear someone is having a child.

“The only reason I survived it is because I went to school, I have a decent job, and so I can afford to pay for ongoing psychological services. Because it depresses you, and that never ends.”

Speaking at the Aids 2014 conference inMelbourne, Mthembu said global action was needed to stop women being forced into the procedure, in the mistaken belief it stopped HIV transmission.

Her organisation, the International Community of Women Living with HIV/Aids, had identified 24 women forced into sterilisation in South Africa in 2014 alone, she said.

The Association for Women’s Rights in Development says forced sterilisation involves surgically removing or disabling reproductive organs without full or informed consent, and is a clear violation of bodily integrity and autonomy.

Namibia has evidence of clear discrimination against women living with HIV/Aids and forced into sterilisation, the organisation reports.

“The problem is we don’t have exact figures on it, but we know from the numbers we do have that they are high,” Mthembu said.



“It’s a personal and private matter, so women can't come out with this easily, it requires sensitive research skills to even get women to speak.

“But if you look for it you find it. In Namibia, of 250 women we have spoken to over the past few years, 48 say they have been sterilised.

“I work in South Africa but this is a global problem. I know in Chile, in Latin America, in south-east Asia, in Thailand and India, there are cases.”

In a study of 285 women in El Salvador, Honduras, Mexico and Nicaragua, Harvard University’s school of public health found healthcare providers were pressing women living with HIV to be sterilised, and sometimes forcing the procedure on them.

The lead author of the research, Tamil Kendall, presented her findings at the conference and said the sterilisation rate ranged from 20% in Nicaragua to 28% in Mexico.

“Reproductive rights are internationally recognised human rights, yet women living with HIV from around the globe continue to report reproductive rights violations, which range from omission of information and services to coercive sterilisation and abortion,” she said.

Healthcare providers pressed women to undergo sterilisation by providing scientifically inaccurate information about pregnancy and HIV, its transmission and progression, her study found. In some cases “evidence” of consent was obtained fraudulently, for example by dipping a woman’s finger into ink while she was under anaesthetic and pressing it onto a consent form as a form of signature.

A separate study presented at the conference, from the University of Campinas in Brazil, interviewed more than 900 women living with HIV aged between 18 and 49 between March 2013 and January 2014. It found one in four had been sterilised.



World Health Organisation figures from 2012 show almost 18 million women worldwide live with HIV, making sterilisation a critical human rights issue, Mthembu said.

“We don’t know why it’s still happening, but it’s obviously associated with HIV-related stigma and some degree of eugenics,” she said.

“I don’t think it has anything to do with access to HIV treatments because they were doing this before women had access to treatments and they are still doing it now in areas where women can access HIV drugs.

But forcing women into sterilisation went beyond stigma, Mthembu said.

“It’s a human rights violation and it’s gendered because we haven't heard of men, gay or straight, reporting they've been forced into sterilisation,” she said.

Her organisation is working with the Women’s Legal Centre in South Africa to take cases of sterilisation to court. It was preparing cases for the criminal, civil rights and equality courts, she said.

But Mthembu said she was also preparing to take the cases to the International Human Rights Court because she was not confident the claims would be successful in her country.

“We’ve tried to engage the South African legal system and government before, and it hasn’t led to anything,” she said.

“It is infuriating. The government’s position is that this is not a problem, it’s a few isolated cases and the doctors carrying it out are just a few rotten potatoes.

“But these are doctors, employed, violating women's rights and they must be held responsible. They are using state resources to carry out unwanted, unnecessary and expensive procedures that require everyone from the anaesthetist to nurses to senior doctors to be complicit.

“This is what it is like to be a woman with HIV in these countries.

“I am angry, and my desire to get justice for these women drives me on.”