Abstinence or a sexually active life? The dilemma, faced daily by HIV-positive women around the world, was discussed by delegates attending the first global conference on women and AIDS, in the Kenyan capital, Nairobi.
Many campaigns have preached abstinence from sex as the best way to prevent the disease, inviting criticism from those who question the efficacy of the strategy. In the case of women with HIV, would abstinence be a desirable alternative? Most women interviewed by PlusNews said abstinence was a personal option, but none of them seemed to embrace it.
"We are sexual beings and we have the right to have relationships. Part of being healthy involves being sexually healthy," said Nigerian activist Rolake Odetoyinbo, of the non-governmental organisation (NGO), Positive Action for Treatment Action. "People with HIV must be at peace with their sexuality in order to protect themselves."
As a result of the rapidly expanding availability of antiretroviral treatment, people with HIV live with a new reality: their health improves and so does their sexual appetite.
"Did you know that antiretrovirals make you horny?" joked Lutanga Shaba, an HIV-positive woman and the director of The Women's Trust, an NGO in Zimbabwe. "It doesn't work to pretend that sex isn't happening."
Through the lens of human rights
Feminine sexuality and sexual desire are realities of life, but society finds it harder to accept when women living with the virus exercise these. One point of agreement at the meeting was that the sexuality of people with HIV should be viewed through the lens of human rights; that women with HIV, like other women, have the right to a healthy sex life.
Delegates noted that a subtle line separated privacy from the necessity of protecting oneself and one's partner from infection or re-infection. "To reveal one's condition should be done voluntarily - because the woman wants to - but not as an obligation," said an activist who did not want to be named.
One of the fears in relation to this issue is that other countries will follow the example of Namibia, which is considering legislation that would place the onus on an HIV-positive person to inform any sexual partner of their status, with a prison sentence imposed on anyone who infected another person.
Deborah Williams, of Trinidad and Tobago, a representative of the Caribbean Regional Network of People Living with HIV/AIDS, emphasised the importance of revealing one's HIV status. "If a partner doesn't say he has HIV, then it is true violence against a woman. We have to lower the rates of transmission by being open, speaking of our condition for our protection; this has to be our promise," she said.
Shaba said the inequality of the sexes also put women at a disadvantage. "If an HIV-positive man discovers that his fiancée is positive, he is certain to abandon her. But if a man is positive, the wedding will certainly go on ... It is a question of gender."
Redefining the terms
Conference participants called for a more realistic approach to prevention than the current ABC strategy of Abstinence, Be faithful, and use Condoms. "You can throw ABC in the trash, it doesn't work," said Shaba.
Peter Piot, executive director UNAIDS, was more cautious, pointing out that although many current prevention programmes were based in the realities of 20 years ago, many achievements had been accomplished.
"We have to be careful to not throw out the baby with the bathwater. Condoms continue to work, but they are not sufficient. Nothing reduced to a single buzzword works with HIV; it is always a combination of factors."