Veronica* did not realize she had been sterilized while giving birth to her daughter until four years later when, after failing to conceive, she and her boyfriend consulted a doctor.
"I was like 'Okay, fine', because there was nothing I could do by then, but I was angry. I hate [those nurses]," she told IRIN/PlusNews. Veronica tested HIV-positive during a routine antenatal visit and was given a form to sign by nurses at the hospital where she went to deliver.
"I didn't know what it was all about, but I did sign," said Veronica, who was 18 at the time and had been scolded by the nurses for being unmarried.
She vaguely recalls being unconsciousness and then coming to and giving birth to her daughter, but did not ask questions about the cut on her abdomen. "My aunt - she's a nurse - went there and asked them what the cut was all about. They didn't answer her; they said it was private and confidential."
Veronica, who is now 28 and working for an HIV/AIDS home-based care programme in Orange Farm, an impoverished township south of Johannesburg, is among a growing number of women in South Africa and other countries in the region who have come forward in the last few years with similar stories of forced or coerced sterilization after an HIV-positive test result.
Local rights groups in Namibia, with the support of the International Community of Women Living with HIV/AIDS, have helped uncover 15 such cases, and a trial involving three HV-positive women who say they were sterilized at public health facilities without their consent is due to resume on 1 September in the High Court.
"It does appear that in Namibia [the practice of sterilising HIV-positive women] has been fairly widespread and systemic," said Delme Cupido, coordinator of HIV/AIDS policy at the Open Society Institute of Southern Africa (OSISA), which is providing funding for the legal action.
|A lot of women didn't know it was wrong that they'd been sterilized|
Similar cases have been uncovered in Zambia, and Promise Mtembu, an AIDS and women's rights activist who was herself sterilized in 1997, is gathering stories from South African women living with HIV whose reproductive rights have been violated.
Some of the 12 cases she has so far documented occurred several years before prevention of mother-to-child transmission (PMTCT) services were available, but the most recent took place in 2009, by which time public health facilities were using a dual-antiretroviral therapy regimen that can reduce the risk of mother-to-child HIV transmission to less than five percent.
Aside from the availability of PMTCT, performing a medical procedure without informed consent is a serious human rights violation and yet, according to Mushahida Adhikari, an attorney at the Women's Legal Centre in Cape Town working with Mtembu to compile cases with a view to taking legal action, "A lot of women didn't know it was wrong that they'd been sterilized."
Mtembu added that, "In many cases [the women] knew what they were signing, but didn't feel like they had a choice."
Mtembu and Adhikari hope to collect enough strong cases to take to South Africa's High Court and, in the event of a ruling in their favour, to present them to the country's Constitutional Court, but "It's going to be a long, hard slog," Adhikari warned. "A lot of the women don't necessarily want to be part of a big class action, they just want an apology."
Often the women do not want to go to court because they have not told their families about being sterilized. Adhikari said the stigma associated with not being able to have children could be as strong as being HIV positive.
|Women take legal action over alleged sterilizations|
|"You're trying to deny me giving birth"|
|HIV pregnancy, stigma and ignorance|
Veronica was quick to disclose her HIV-positive status to her mother, but still has not told her about the sterilization. Her previous relationship ended after the revelation that she had been sterilized, but her new boyfriend wants a child and the couple is seeking advice about whether the procedure can be reversed.
Reversal may be possible, depending on how the sterilization was performed, but the procedure is difficult and too expensive for most of the women.
Veronica said she "wouldn't be okay" if tests revealed her sterilization could not be reversed, but had decided not to take legal action against the hospital that performed the procedure. "It is late for me," she said. "But for other women, I think they have to."
*Not her real name