Janelle is determined that before her 23rd birthday, she will have her second child. The 22-year-old is HIV-positive.

"I don't know how long I am going to live," she says candidly. "Yes, there is medication to make me live longer with HIV now, but opportunistic infections can come anytime. I know I have HIV, so I want to have my child early so I can be around for him/her as long as possible."

Janelle has a five-year-old daughter and lives with her 20-year-old boyfriend, who does not have a child. He is aware of her status but still wants her to have his children.

As antiretrovirals become more widely available in Jamaica, a significant number of women living with HIV are opting to have children, a situation many never thought possible five years ago. However, many report that their reproductive health rights are not always respected by health personnel.

Right to become pregnant

Twenty-nine-year-old Ericabecame pregnant last year, her first pregnancy since being diagnosed with HIV five years ago. "They (health officials at the clinic where the pregnancy was confirmed) made me feel that I had no right to become pregnant," she says.

In the Caribbean, which has the highest HIV prevalence outside of sub-Saharan Africa, an estimated 50 per cent of HIV-positive persons are women. The need to address the sexual and reproductive health rights of HIV-positive women is all the more significant because three-quarters of people living with HIV in Jamaica are in their reproductive prime.

Dr Debbie Carrington, care and treatment coordinator for people living with HIV at the Ministry of Health in Jamaica, says Erica should not have been told that she has no right to get pregnant, because she is HIV-positive.

"We try to prevent unwanted pregnancy in HIV-positive women, just as we do in those without HIV, with counselling and family planning services, primarily in the primary-care health centres. When women who are HIV-positive get pregnant, we try to prevent their babies from getting HIV."

The Health Ministry's policy position, however, does not always translate effectively into practice.

Dr Tina Kong, a medical doctor at the Comprehensive Health Clinic in Kingston for 16 years, admits that while public health clinics should provide a wide range of services on sexual and reproductive health to patients, this doesn't always happen.

Contraception

"Contraception services in clinics are integrated in thought but not in action. So, if you go to the family-planning clinic, you will hear everything about contraception, but if you are at your general clinic or STI clinic (at the same facility), you may not hear much about contraception," Kong explains.

She says some health care providers at the clinic, who counsel patients, are not properly trained to do so.

Chronic staff shortage means workers have to spend less time with patients, limiting the amount of information that can be passed on.