Preventing Project Prevention

After years of working in the United States, an organization that pays female drug users $300 to agree to be sterilized has begun branching out to other parts of the world. Following a lukewarm reception in Britain, Project Prevention has now turned its attention to Kenya, where it plans to start paying women living with HIV to accept long-term contraception.

Project Prevention is headed by Barbara Harris, who started the organization in 1997. It was initially named CRACK (Children Requiring a Caring Kommunity). While her PR has become more sophisticated in recent years, Barbara Harris has famously been quoted as saying, “We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.”

In Britain, human rights groups have been working actively to oppose Project Prevention. Initially it hoped to offer drug users money to be sterilized there too, but faced with the British Medical Association’s stringent ethical requirements, it decided to settle for offering payment for long-term contraception instead.

Now Barbara Harris has her sights on Africa, with her first stop in Kenya. There, she claims she has found a doctor who will insert intrauterine devices (IUD) into HIV-positive women for a fee of $7 a time. Not only will Project Prevention cover the cost, Harris also plans to offer women agreeing to this procedure a one-time cash payment of $40.

In a press release, the organization says that in addition to working to “cure” infants of AIDS, there is an urgent need to “prevent future pregnancies that may result in infants born HIV positive who would suffer daily and most will die before age 5.”

Of course, we can all agree that “All this human suffering is preventable.” That is precisely why treatment activists have been pushing for more widespread adoption of measures to prevent mother-to-child HIV transmission (PMTCT). The best PMTCT regimes currently recommended (which include putting the mother on full antiretroviral treatment) have been shown to make the risk of mother-to-child transmission virtually nonexistent (the WHO guidance on PMTCT suggests a risk of less than 2 percent; other estimates put the risk at less than 1 percent). If Barbara Harris were really concerned about ending suffering, she would be working night and day to ensure all HIV-positive women have access to and benefit from evidence-based HIV treatment and PMTCT services.

But Project Prevention seems to have no knowledge of antiretroviral medications (ARVs) or PMTCT, since they claim that getting HIV-positive women on long term birth control is “the only way” to ensure there are fewer babies born with HIV.

The move to Kenya certainly does not seem like an accident. From its inception, Project Prevention has targeted black women and poor women (read this expose from the Committee on Women, Population, & the Environment). And long-time opponents of Barbara Harris and Project Prevention point out that while she and her organization claim to be concerned about scores of unborn babies, they seem to show no similar compassion towards their mothers.

For example, she makes no mention of any need to offer ARVs or other medical treatment to women living with HIV. Nor is there any indication of medical follow-up for the women accepting the IUDs, or financial assistance should they subsequently want them removed. Furthermore, the ethics of offering financial incentives to influence what should be carefully considered medical choices, are highly questionable. The $40 being offered to Kenyan women represents a large sum in a country with an average per capita GDP of $315.

Right now a group of HIV-positive Namibian women are in court demanding redress and an apology from their government, after they were sterilized against their will and in some cases, without their knowledge—simply because of their HIV status (read the trial blog at endforcedsterilisation.wordpress.com).

On the surface, offering HIV-positive women money to accept long-term contraception may not seem quite as bad as coercive or forced sterilization. But both practices stem from the same root–the belief that certain women, including those with HIV, have no right to have children. This is a pernicious belief that is founded on nothing but ignorance and prejudice. Instead of working to restrict women’s reproductive choices, surely we should be fighting to ensure that all women have access to the medicines and health care they need for themselves and their families.