Preventing Project Prevention

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

Project Prevention is headed by Barbara Harris, who started the organisation 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) devices into HIV positive women for a fee of $7 a time. She also plans to offer women agreeing to undergo this procedure a one-time cash payment of $40 – bringing the total cost to $47 per procedure.

In a 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 anti-retroviral treatment) have been shown to cut the risk of mother to child transmission to between 2 and 5 percent. If she were really concerned about ending suffering, Barbara Harris 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 anti-retroviral 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. 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 ARV 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 dollar 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.

On the surface, offering HIV+ 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.–Brett Davidson

Comments

comments

19 Comments
  1. Agreed that paying people to undergo medical treatments is ethically problematic (and this particularly organisation is obviously not one Africa should be stuck with) but maybe not fair to assume that these women will accept long-term contraceptive options merely because of the money. It is not the same as the situation in Namibia. Some women might choose to access long-term, woman-controlled, unobtrusive contraceptive options because they don't have access to affordable contraceptives otherwise. Of course it is bad. That's obvious. I'm far more outraged that women's choices are so limited in terms of contraception and childbirth, whether HIV positive or not, that they're forced to consider options like this.

  2. The fact that Project Prevention has moved from women who use drugs to HIV positive women reveals the goal of the project for what it is: eugenics to stop the "undesirables" from reproducing. Increasing access to affordable contraception is of course critically important. So is accessible medication and services for the prevention of mother to child transmission of HIV (the real project prevention). Let's hope Kenyan women can find support from other sources, without such questionable motives, to keep themselves and their families healthy, and without having to hear the message–yet again–that HIV positive people don't deserve or can't take care of children.

  3. It is outrageous that this should be coming under the banner of “Medical News”

    Birth control MUST BE a choice and a choice that should be made with well informed consent…offering money for such a thing is totally unethical!

    The article does not mention HAART nor does it push its availability for all!
    It doesn’t mention it as successful treatment for all of us living with HIV nor its potential treatment as prevention of HIV transmission.

    It doesn’t even mention the availability of treatment for PMTCT and how effective it is!

    We are not dogs – we are not “undesirables”. We are women living with HIV, sometimes co-infected with HCV, TB, and might even be drug users…
    What we need is a supportive environment, with access to treatment for all and the information and the options to make informed choices.

    Carmen

  4. I read this article and thought….at this time and age, someone can actually be taking advantage of women's vulnerability for $7. it is shameful and unfortunately Barbara Harris sees herself as a savior the same way the people with warped minds use their skills for destruction across the globe. With such brilliance and perfect fund raising skills Barbara would do well to create programs that heal and that don't leave a sour taste in everyone's mouth i.e. those of us who see ourselves as development workers working to find solutions for the community. I am Kenyan and I appalled at this information. I would like to request like minded human rights activitist to find a way to talk to the women that took the money and see what was the motivation…the money or the long term contraception…i can gurantee it was the money…which makes very sad hence the exploitation because the money offer creates a "power over" relationship between the recipient of the services and the provider. I am sad indeed..

  5. Barbara Harris' Project Prevention is an abusive misallocation of resources. Instead of using her funds to promote access to high-quality family planning services, she is paying women to accept the option she chose for them. Instead of using her funds to ensure that all women with HIV can have the healthiest families possible, she is paying women not to have families. If she really wanted to help women with HIV in Kenya, she would ensure that they have the resources needed to make their own decisions.

  6. paying women living with HIV to under go long term contraceptive is no big deal. I think Kenya women should consider themselves lucky. i know many women living with HIV that would jump to the offer in my country, especially in the clinic where i am a volunteer, there are a lot of unwanted pregnancies leading to babies born with HIV …yes i agree that there should be proper orientation and counseling but the bitter truth is some people still do not believe in othrodox medicine in Africa so please lets encourage Barbara .

  7. Our program is intended to prevent HIV entry points to children by infected mothers as the vehicle of transmission during pregnancy, during birth and during breastfeeding. It is therefore far reaching in scope yet succinct. We realize that there are several factors that conspireto make it possible for infected women to still give birth to 50,000-60,000 infected children annually in Kenya under the watchful eyes of existing interventions and numerous organizations working around the clock to make this not happen. Postpartum infections are on the rise because women lack resources to acquire commercial formula leading to breastfeeding as the only means of nutrition thereby exacerbating virus transmission to the born child. Previous methods of preventing new infections in children have not been entirely successful especially in places we intend to work. When everybody is talking of the rights of the woman, we focus on the rights of the child to be born healthy, the right of the child to parental care and ultimately there right to life.Indeed,the opening words of Universal Declaration of Human Rights are…every human being is born free and equal in dignity and right.Dignity,right and freedom are grossly violated and compromised when children are born with the virus and as a consequent die before five or have to contend with taking care of their ill parent, life in the streets, early marriages, forced labor and heads of households. We are child-centered so it is only natural that we bring the child’s perspective in conversations we make and programs we do.
    Our considered project is consistent with the United Nations Strategic Approach to Prevention of HIV infection in infants thus:
    1. Primary prevention of HIV infection in women.
    2. Prevention of unintended pregnancies in women living with HIV.
    3. Prevention of transmission from women living with HIV to their infants.
    4. Provision of care, treatment and support for women living with HIV and their families

    Most programs have focused on Element 3 and the provision of a package of services seeking to reduce mother-to-child transmission of HIV, including HIV testing and counseling in antenatal care settings, antiretroviral (ARV) drug prophylaxis given to HIV-positive mothers and their infants, safer delivery practices and counseling on and support for infant feeding. Elements 1, 2 and 4 have, however, received less attention. We don’t intend to duplicate what others are doing. We are aware that this approach has been hindered by myriads of issues including access to health facilities, educational level, geography, residence, marital status and most importantly low level of awareness of HIV status. In Kenya for instance, as many as four out of five HIV infected persons don’t know their status, 84% need CTX but don’t know their status. Add this to the fact that prevalence rate in women is 8.7 percent as while 5.6 in men and you will know why we work with this constituency not because we discriminate but because they need our services the most. In our approach, we focus on element 2 which is just another paradigm.
    We understand that in order to turn the tide against the rising levels of HIV and AIDS in women and children today, a bold,fresh,innovative and creative approach is required which gives greatly increased emphasis to supporting reproductive choices and meeting unmet need for family planning. Among our key messages are the following:

     Reproductive health that make people able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant We understand reproductive health in the context of relationships: fulfillment and risk; the opportunity to have a desired child or alternatively, to avoid unwanted or unsafe pregnancy. We achieve this by spreading evidence-based information to make the infected make informed choices reproductive health choices.

     We view birth control is a potent instrument in preventing HIV in women and children. We are expanding and intensifying long term birth control to meet a large unmet need for family planning among all women. Infected women who know their status are in particular need of services that can help them to make informed reproductive decisions and provide them with contraception options. This, in turn, can be expected to avert HIV infection in infants by enabling interested women to prevent or delay pregnancies.

     Long term birth control provides intrinsic benefits by saving lives and enhancing the health status of women and their families. Enabling women to time and space births leads to important improvements in their health, combats maternal mortality, and significantly increases child survival.

    Financial aid
    We aim to incentivize infected women with a view to engendering uptake of HIV treatment, care and prevention, filling the gap of family planning through long term birth control and HIV status awareness. We are working in areas where lack of HIV awareness status makes it hard to benefit from programs intended for prevention, care and treatment. By giving minimum threshold of financial aid, we will reduce poverty in the very short run and to improve the accumulation of human capital for the next generation. Giving an incentive is a small prize we are willing to pay to ensure an HIV free world and alleviate suffering from innocent children.

    Willice Okoth Onyango
    Project Prevention Africa Coordinator.

  8. Unfortunately I believe the following sentence from this lengthy justification of Project Prevention in Kenya shows us why this organization’s approach has been found suspect in both the UK and the US: “When everybody is talking of the rights of the woman, we focus on the rights of the child to be born healthy, the right of the child to parental care and ultimately their right to life.” This statement presupposes a false dichotomy between children’s and women’s rights and insists that either one or the other be privileged. Promotion of HIV status awareness is important, but long-term birth control does nothing to prevent sexual transmission of HIV. Condoms, properly used, do that.

    1. Albert,I really does.Delaying these pregnancies while empowering women socio-economically especially in poor regions helps.We are organizing women in groups of 10-15 then give them financial aid to engage in income generating activities.Condoms are distributed here for free but still the pandemic is persistent.That is a perfect explanation of what works not.It would be insane for us to duplicating efforts that have proven to all who have eyes and conscience their inability to bring hope.

  9. I live in Kisumu, hiv positive and living positively. Im very much interested in this program by Barbara Harris. I have included my contact details for easy reference. Kindly get intouch with me as soon as possible.

  10. Sadly most of the negative comments made about me and things printed that I was supposed to have said are all untrue! Lies are so easy to print and then rather then contact me personally for an interview reporters go back and dig up the lies and reprint them. Visit http://www.ProjectPrevention.org if your interested in knowing the truth about Project Prevention and Barbara Harris.
    Thank you

  11. If children weer to be asked before being born as on which option to take between living as orphans and child laborers, living in children's' homes under the care of the world rather than actual parents, if they were to be asked to choose between living on the streets of Kisumu, Eldoret and Nairobi, cities both of which are in Kenya, and not being born at all, I believe we can all give a genuine answer that they would have given- be we the children asked to respond; before we were born.
    I believe this is a matter of logic and should not draw unnecessary arguments. During this time of human evolution, you cannot expect ignorance and lack of proper planning to take charge. We should only defend cases that actually deserve the defense. And the fact is that it defies logic to give birth to children that youcan't take parental care of.
    If the women be so desperate to trade the so called rights for only 40 US dollars, the what; answer me if you are sore do they have to leave for the caring of these children upon their; sorry but demise.
    We are living in the age of sustainability and everybody should just cut their coats according to their sizes. No excesses of either children or any other thing should the world allow in. In as much as the women have rights, the children also have rights that should even be given priority. You cant blame them for being born and for the following suffering that they are forced to endure. In fact, these are children that will live pain and discrimination for ever.
    Get me to help you with the work Mrs. Harris

  12. Any woman who says this is not deserving of the benefits Sojourner Truth and Susan B. Anthony fought for.

    The fact that you are using the same arguments that eugenics advocates have used for centuries cannot be lost on anyone.
    http://en.wikipedia.org/wiki/Eugenics_in_the_Unit

    You are using the same words that have always been used to justify the extermination of a race other than your own.

  13. im sick of tv ads asking for money why should we pay for them having children
    it maybe there choice tp use condoms etc
    there amaking it worst by having moire children that suffer
    any women who has a child and knows they will starve is not a mother

  14. If a person is not stable minded enough to choose whether or not she takes birth control, why is she stable minded enough to bring children into the world and (not) raise them?
    I’d rather have her take money to use contraception than take money from selling her kids into sex trafficking or getting a welfare check and neglecting the kids.
    Besides, have we forgotten that most women pay a LOT of money for birth control. Why are ignorant people assuming these women wouldn’t want the birth control if they were clean and could afford
    it?
    Anyone that opposes this program is prejudiced against people that are at a socioeconomic disadvantage. They cry because women can’t get free birth control and then when the women do get it they cry again because they think those women are too stupid and desperate to be able to make choices for themselves. The people against this are idiots and should be sterilized themselves.

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