(Bloomberg) — State hospitals in South Africa have sterilized some pregnant HIV-positive women without their consent, according to an investigation by the government’s Commission for Gender Equality.

The investigation was prompted by a 2015 complaint by the non-profit Women’s Legal Centre, which documented 48 cases where women were allegedly either forced or coerced into agreeing to the procedure while giving birth.

South Africa has the biggest HIV epidemic in the world, with a prevalence rate of 13% and about 7.7 million people living with the virus that causes AIDS. The impact of the epidemic on family structures and life expectancy has led to widespread stigmatization of those who are affected by the virus.

Medical staff breached their duty of care and subjected the women to inhumane treatment, the Commission for Gender Equality said in a 57-page report Tuesday. Doctors and nurses told some of the HIV-positive women that they should not be having children and that they would die if they didn’t get sterilized following delivery. Many agreed to the procedure by signing forms they didn’t understand.

When one of the women asked what the forms were for, her concerns were dismissed by a nurse, according to an affidavit.

“You HIV people don’t ask questions when you make babies. Why are you asking questions now?” the report quoted a nurse as saying. “You must be closed up because you HIV people like making babies and it just annoys us. Just sign the forms, so you can go to theater.”

Read more: 3 Things People Get Wrong About the History of HIV and AIDS

The commission urged the Health Ministry to act to end the practice and provide redress to the affected women. Health Minister Zweli Mkhize said he will meet the commissioner to discuss the contents of the report. The meeting will take place later on Tuesday.

While the report didn’t state how many women have been affected, it would be wrong to assume that the practice may not still be occurring, said Nasreen Solomons, an attorney in the Women’s Legal Centre’s sexual and reproductive health and rights program.

Women need to know that they should not be compelled to give their consent for the procedure “when they are in pain or placed under duress or conditions that do not allow them to provide their consent free of coercion, stigma, discrimination, harm and judgment,” she said.

The range of redress could include holding medical staff accountable to providing affected women with compensation and psychological support, Solomons said.

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