RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec.

, 2010

[www.reciis.cict.fiocruz.br]
e-ISSN 1981-6278

Original article

HIV/AIDS, reproductive rights and

reproductive technologies: mapping
different perspectives
DOI:10.3395/reciis.v4i5.368en

Eliane Portes Vargas Abstract

Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil.
This work aims to understand how the HIV/AIDS issue has been questioned in the Public
[email protected]
Health field, in its interface with the field known as “sexual and reproductive rights” and
Ivia Maksud reproductive technologies as a technological innovation still seldom discussed in the
Instituto de Saúde da Comunidade/Universidade Federal context of public health policies. Therefore, it examines the current debate milestones
Fluminense, Niterói, Brasil encompassing medically assisted reproduction, in view of the different approaches
[email protected]
found in the academic literature on the subject within the scope of public health
Luciane da Costa Moás policies aimed at HIV/AIDS and for women. We assume that historical issues and
Instituto de Ciências Humanas e Sociais da Universidade policies concerning the build-up of these fields are reflected in the way this topic, still
Federal Rural, Rio de Janeiro, Brasil uncommon in the examined literature, has been discussed. The developed analysis is
[email protected] supported on available studies on this field, official documents and print media, and
brings together a collection of reflections on the themes assisted reproduction, HIV/
Ruth Britto
Centro Universitário Plínio Leite/UNIPLI, Niterói, Brasil AIDS and reproductive rights.
[email protected]

Keywords
HIV/Aids; reproductive technologies; reproductive rights

In the context of HIV/AIDS, the assisted reproduction studies performed in this field, official documents and print
techniques have been developed in some European countries media, and brings together a collection of thoughts on the
and the United States since 1992, but consist of technological assisted reproduction, HIV/AIDS and reproductive rights. The
innovation still seldom discussed in the context of public health dissemination of information on the subject on media in
policies. In Brazil, some private clinics and public universities Brazil already has been the focus of the studies due to their
perform such procedures, and there is even an initiative, still relevance in the production of science and dissemination of
incipient, of the Ministry of Health to provide this capability in scientific knowledge. Generally the media become, therefore,
public health. key channel for the dissemination and popularization of
Thereafter this work seeks to understand how the HIV/ health related issues. Taking these aspects and low visibility
AIDS issue has been questioned in the Public Health field, in and public debate on the issue into account, we identified
its interface with the field known as “sexual and reproductive materials available on the subject since 2001.
rights” and reproductive technologies. Broadly the objective A survey on the relevant literature production showed
is to bring forth the milestones of the current debate almost no analysis of assisted reproduction for HIV/AIDS,
encompassing assisted reproduction, in view of the different particularly regarding to examine the reproductive rights and
approaches found in the academic literature on the subject to discuss reproductive technologies. The arguments raised
within the scope of public health policies aimed at HIV/ by different stakeholders on the subject - linked to social
AIDS and to women . The analysis is supported on available movements and government departments are available in

3
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

dossiers, bulletins and print media - point to an intermittent HIV/AIDS and reproduction: epidemic context
debate, with different positions, ranging from claims of and government initiatives scenario
comprehensive care to seropositive people to questions about
The epidemiological profile of HIV/AIDS that is embedded
spending priorities in policies for HIV/AIDS and the state’s role
in Brazilian society today reflects growing number of AIDS
as a funder of this procedure. The assumption is that historical
cases in women, especially in the lower income class and
issues and policies concerning the build-up of these fields are
in the periphery of urban centers (BRASIL, 2007). Decades
reflected as dissociated as this subject has been discussed,
ago, the data indicated a predominance of cases among men,
in which little expression of the tensions present in public
a situation that was sharply and not so recently changed.
debate, still rare in the researched literature, is shown.
Between the years 1980 and 1990 the male/female ratio
In the reproductive experience the representation of
of cumulative AIDS cases was 6:1 (in the early 80s, this ratio
individual “choice” and “freedom” prevails (VARGAS et al.,
was around 25:1), and is currently 1:1 (BRASIL, 2006).
2007, and this occurs in sexual experience also (VARGAS
Since 1996, with the provision of free and universal
et al. 2010). This ideological property in the sexuality and
antiretroviral drugs (ARVs) by the Brazilian government,
reproduction field is also a fundamental premise of sexual
the expectation and quality of life of seropositive people
and reproductive rights (CORRÊA et al., 2003; BARBOSA et
has extended. AIDS is now considered treatable chronic
al., 1997). It should be noted that the reproductive decision
disease, and lethality of the epidemic in Brazil has decreased
is enhanced by reproductive technologies. In this direction,
significantly. It is reasonable to suppose that these changes
the analysis of the uses and values of the desire to have
bring to the virus carriers an enhancement of the future
children among different groups shows the connections
perspective and encourage the investment projects in guiding
between reproductive practices and medicalization, as well
everyday life. In this sense, the emergence of reproduction
as a strong association between desire to have children and
project is a particular case, in which it is expressed in a broader
medical conceptive technologies, since they are characterized
process of the redefinition of the relationship between the
as a modern way, increasingly popularized and medicalized,
subject and disease (MAKSUD, 2002, 2007).
to conceive.
In addition to individual care, antiretrovirals bring up a
Several studies suggest that assisted reproductive
symbolic revaluation of the reproductive process, previously
technologies allow dissociating: sexuality and reproduction;
considered incompatible with the virus presence, against
conception and affiliation; biological affiliation, and affective
the possibility of to be transmitted to the fetus. Currently,
and educational links; and biological mother, educator and
there are technical possibilities available in health services
tutor mother. These studies cover a range of controversial
for seropositive women who wish to become pregnant. In
issues, regarding the beliefs, representations and reproductive
public services, there is treatment with specific drug (AZT)
practices, as interplay between medicine and reproduction
for pregnant seropositive women . The more specifically
(CORRÊA, 2001), and sexuality and reproduction (SALEM,
epidemiological literature informs that the Protocol Nr 076,
1995; NOVAES et al., 1995; PIQUOT, 1997). Through these
clinical trial that proved the effectiveness of the AZT drug to
perspectives, there are intricate relationships between the
prevent perinatal HIV transmission (from mother to child), is a
female body, medicine and reproduction, as a consequence
milestone in the field (GRINSTEJN, 2002). From this protocol,
of a historical process in which the theme of technological
there have been several others, whose recommendation
innovations in the reproductive medicine field is a recent
presents the drug as an effective therapeutic use, even by
phenomenon, and is still most its recent approach to the HIV/
women in more advanced case of the disease (GRINSTEJN,
AIDS theme.
2002). With the availability of this particular product, the
The text herein presented is structured in three parts: the
first part describes the current HIV/AIDS situation in Brazil, perinatal transmission rates strongly fall. As the literature
the emergence of discussions on human reproduction in this reports (SAUER, 2003; FAUNDES, 2002; MAKSUD, 2002),
scenario and describes government initiatives in this field; on average, the risk of transmission is around 2%.
the second part shows how the assisted reproduction related In 2001, the Center for Human Reproduction of Unicamp
to HIV/AIDS has been thematized in available literature and (Cemicamp) performed - in the first time in Latin America – a
highlights the involved aspects; and finally, the third part purified fertilization with sperm from a seropositive (FOLHA
shows evidence of current controversies surrounding the ..., 2001). In that year, Cemicamp offered treatment, but not
broader inclusion of reproductive technologies in the health afforded the medicine costs, which were imported (FOLHA...,
system and focus on the HIV/AIDS theme. 2001). In 2003, the Special Secretariat of Policies for Women

4
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

of the Presidency (SPM) was created, to play an important role In February 2008, the current Minister of Health, José
as articulator of federal government policies toward women. Gomes Temporão, has publicly stated that More Health
In 2004, the National Plan for Women (PNPM) was launched. Project (Projeto Mais Saúde), “which aims to increase access
Its goals were “to promote universal access to comprehensive and quality of services provided by the Brazilian Unified
care in STD/AIDS for women; to reduce vertical transmission Health System”, among other sets of actions, “will be investing
of HIV and syphilis; to promote quality of life of women living in sexual and reproductive rights, by creating of centers for
with HIV/AIDS in the context of human rights, sexual rights assisted reproduction” (BRASIL, 2008a). The document,
and reproductive rights” (MINISTÉRIO..., 2008a), aiming to however, makes no mention of assisted reproduction for HIV
address the feminization of the HIV/AIDS and other STDs. carriers, but refers to the increase of the supply of contraceptive
One of the activities under the program was the formation, methods (contraceptive, diaphragm, condom, IUD) and the
in 2005, of a workgroup (WG) to structure an integrated implantation of assisted reproduction centers in five federal
agenda for effectuation of reproductive planning in couples universities until 2011 (MINISTÉRIO..., 2008a).
living with HIV as part of the National Policy of Comprehensive Nowadays there is silence on the assisted reproduction
Care in Assisted Human Reproduction/adoption under the and HIV/AIDS subject, and no documents are available to
Braziian Unified Health System (SUS) . The project was part inform the current status of this debate.
of Sexual Reproductive Rights Policy, launched by the Health
Minister Humberto Costa, at the International Women’s Day Assisted Reproduction, HIV/AIDS and
of 2005. Among the proposals of the National Plan on Sexual reproductive rights: involved aspects
and Reproductive Rights for the WG, was the creation of 21
The literature on assisted reproduction and HIV/AIDS in
centers for assisted reproduction for infertile couples, six of
the social sciences is scarce in Brazil, but has been booming
these centers for the HIV patients (MINISTÉRIO..., 2005).
in biomedical fields. Aiming to understand the diverse way
This group was formed by several scientists and activists from
in which the subject matter is outlined, a research on the
Brazil who were somehow involved with the subject.
Scielo Brazil database was made, to find articles on the topic
This guideline contained some criteria, both social and
produced until 2009, by using a combination of descriptors:
medical, to perform the procedure. According to a news
reproductive technologies, assisted reproduction, reproductive
story, “before treatment, the couple would have the option
rights; HIV/AIDS; reproductive health; and reproduction. Only
of adopting a child” and “couples with genetic disease or
10 texts that deal with HIV-related reproduction was found.
infectious diseases, like HIV and hepatitis B, also would have
There was no significant investment by the researchers, on
assistance in order to avoid transmission of diseases for
topic discussion on seropositive reproduction, in the articles
babies” (AGÊNCIA..., 2005). The work of this WG resulted
reviewed so far. Besides this, we made a survey of 44 articles
in the publication of Ordinance 426 (BRASIL, 2005),
on family planning, published in the SciELO database in the
which established, within the NHS, the National Policy for
same period. That indicated the centrality of the contraception
Comprehensive Care in Assisted Human Reproduction by the
actions in analysis of family planning (WILLELA et al., 2009).
Ministry of Health, whose programmatic bases predicted the
That survey, however, did not result in articles that contiguously
primary, middle and high complexity in health care to couples
addressed topics reproductive technologies and HIV/AIDS.
with fertility problems, suffering from infectious diseases such Aquino (2006) conducted a study aiming to describe the
as viral hepatitis, syphilis and AIDS, or genetic, but wanting to profile and trends of scientific activity on gender and health in
have a child (BRASIL, 2005). Brazil, from a large survey that included, in addition to articles
In 2007, the SPM and the Ministry of Health (the National in periodicals, the thesis database of CAPES. According to the
AIDS Program and the Technical Area of Women’s Health) author, the results confirm the marked growth of scientific
launched the Integrated Plan to Combat the AIDS Epidemic production, and 98 master dissertations, 42 doctoral thesis,
Feminization and other STDs, which includes the “women and 665 articles on gender and health were found. It is
and their specificities” without no mention to reproduction intriguing to note that among the subjects divided into five
and HIV. With the recent ministerial changes, nothing else has subgroups by the author, the STD/AIDS featured prominently
been expressed publicly or on the ordinance on the issue in the subgroup sexuality and health.
of assisted reproduction for seropositive in public health. Codes et al. (2002) analyzed the prevalence of STDs,
Throughout the discussion process, many controversies have among them, the HIV infection among women in a family
been generated, as will be shown later. planning clinic of the Public Health System, and investigated

5
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

the relationship of these women to health services. Despite women, including access to prevention practices, adherence
locating its discussion in the context of reproductive health, to treatment and reproductive decisions, from the exploratory
the tone of the discussion was the contraception, and the study conducted in 1997 at a clinic for a referral center in
issue of reproduction itself was not addressed. Hassen (2002) the sexually transmitted diseases and AIDS field, located in
discussed a method of intervention in the popular groups, São Paulo. The authors conclude that the intention of having
covering topics related to sexuality and reproductive health. In children does not change substantially in women, as a
this article, the reproduction subject appears to be related to consequence of HIV infection.
the topic of teenage pregnancy, which was a problem for the Paiva et al. (2002b) conducted research with 250 men
group of women studied. (heterosexual) HIV carriers, on reproductive health subject,
Increasing production on the theme of youth and AIDS has and compared these data with studies among seropositive
been seen in recent years. However, in most scientific articles, women. The authors show that 43% of men and 20% of
the AIDS subject is not linked to reproduction, instead, again, women want to have children, especially those who have no
to sexuality. Ventura and Correa (2006), when discussing the children. The authors report also that the level of reproduction
cultural and legal constructs around sexual and reproductive among seropositive people is still low. In this article, the
rights of adolescents, show that from the expansion of human assisted reproduction subject is mentioned as a possibility,
rights a real change in social habits was produced. The authors although not associated with the data collected and used for
show the difficulties of the Brazilian scenario to enforce and discussion throughout the text.
interpret the specific legislation, especially in dealing with Studies on human reproduction in general and particularly
adolescent sexuality and reproduction. those that focus on individual reproductive decisions, as part
Peres et al. (2002) discussed practices and attitudes of marital heterosexual relationship, have assumed increasing
related to AIDS prevention among male adolescents in a importance in discussions on HIV/AIDS. Moreover, they are
detention center in the State Foundation for the Welfare of consistent with the current trends of the HIV/AIDS, especially,
Minors (Febem) in São Paulo. The authors conclude that its feminization trend, which indicates that most women who
these teenagers had elevated risk of acquiring HIV. However, acquire the HIV virus are found in reproductive age. Thus,
no specific discussion on reproduction and AIDS is made in reproductive decisions in the context of marriage between
the article. Another text (PAIVA et al. 2002a) strives to describe people who are - at least one of them - seropositive, suffer
the overcoming of the notions of “risk group” among young through the affirmation of values, interference in marital
people of São Paulo, from the discussion on prevention relations by the family and peers network (KNAUTH et al. ,
projects that highlight, for example, the reproduction subject. 2002; MAKSUD, 2002). Thus, it can also be said that doctors
Silva et al. (2002) also addressed the youth subject, focusing and other health professionals contribute to this statement of
specifically on the young male, from the values spread among values and meanings related to reproductive choice.
professional football players. The researchers show that Regarding the debate on assisted reproduction procedures
the group had a high degree of information regarding the related to HIV/AIDS, Faúndes (2002) demonstrates that the
ways of HIV transmission and low level of knowledge about seropositive reproduction can be made in two forms. One
reproduction and STDs. is for women with HIV: prevention of vertical transmission,
Diaz (2005) evaluated three programs of sex education with the use of AZT and caesarean section prior to rupture of
and citizenship in public schools of Rio de Janeiro, Belo membranes, which reduces the risk of perinatal transmission
Horizonte and Salvador, through a cross-sectional study of HIV to 2%. The other is the assisted reproduction for
that compared adolescents from the 5th to 8th grade who couples where the man is seropositive and the woman is
participated in the projects, with adolescents from non- soronegative . The fertilization with purified sperm from
participants schools. The survey results show differences seropositive, or “sperm washing”, is a specific type of assisted
regarding the learning of young people, according to the reproduction, through the elimination of the virus in semen,
place searched, but stressed that in all cases, there was an thus allowing a seropositive man and a seronegative woman
understanding of the AIDS theme, which was not directly to have a child without HIV transmission (FAUNDES, 2002) .
associated with the reproduction theme. This new field of HIV/AIDS highlights issues that go
Only two articles from this survey point reproductive beyond the technical expertise, and are linked to values
decisions against AIDS: Santos et al. (2002) investigate issues that govern perceptions about HIV/AIDS, when it comes to
relating to sexuality and reproductive health of seropositive reproduction. Some studies indicate, for example, health

6
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

professionals’ fear in relation to seropositive reproduction. The representation of reproductive technology resources,
Considering the low percentages of perinatal HIV transmission in order to equate the absence of children within marriage,
in the case of pregnant women who use anti-retroviral drug has been characterized as desired or preferred way of
(GRINSTEJN, 2002), the factor that is symbolically associated solving this problem, especially among the upper class of the
with seropositive reproduction of HIV-positive man or woman population or more privileged with material conditions that
appears to be largely a “social risk” (MAKSUD, 2002, 2007, guarantee access to such resources. The problems created
2009; PAIVA, 2007). This is a point of tension with regard to by non-reproduction, the manifestation of the desire to have
prevention of vertical transmission, on the one hand, and the children - either because of infertility, medically defined as a
free exercise of reproductive rights (BARBOSA et al., 1997), category, disease or condition, which includes the HIV/Aids
on the other hand. are faced today with resources advanced medical technology
It is worth reflecting on some symbolic issues, raised from and, following a historical tradition, women were more likely
the sperm-washing, since thoughts in the social sciences have to use (ROHDEN, 2002; VARGAS, 2006).
pointed out that the development of modern conceptive Currently, there is no law in the formal sense (discussed,
technologies replaces the female reproductive body as a focus voted and approved by regular legislative process) on assisted
of interest in medicine (CORRÊA, 1998, 2001; LUNA, 2004; reproduction. The New Civil Code (Law Nr. 10.402/2002)
NOVAES et al., 1995; RAMÍREZ-GÁLVEZ, 2003; STOLCKE, addresses a few questions on the subject. Regarding the
1998; TAMANINI, 2003; VARGAS, 2006). In the specific case definition of kinship, there is no provision on access to new
of sperm washing, besides placing the man at the center of reproductive technology, supervision of clinics, risks, etc. Since
the debate on reproduction, driving the values of a social 1990, there are law projects on the subject in the National
phenomenon seen as feminine, the ideal plan of reproductive Congress. Although the first test tube baby in Brazil was born
rights is maintained and made possible from this technique, in 1984, only the Resolution Nr. 1358/92 of the Federal
which offers the real possibility of a medical posture favorable Council of Medicine (CFM) is applied, which has no law force
to reproduction in the AIDS context. Moreover, with sperm but remained the major reference for the application of these
washing, seropositive reproduction would be no longer a risk, reproductive techniques.
in terms of transmission to the partner and to the child . This fact becomes interesting for two aspects: in the
According Faúndes (2002), until recently ago, a pregnancy absence of law, CFM takes the regulation place occupied by
for a serodiscordant couple or seroconcordant would bring it, and the law issue has generated an expectation around the
undesirable consequences, such as frequent hospitalizations, advent of a new law, as if the legislation itself were able to
children abandoned or orphaned, low quality of family life. solve highly complex issues, most of the time (MOAS, 2006).
Faúndes shows that the attitude of medical institutions had The current legislative debate on the use of reproductive
always been negative, and their concern, despite the couple technologies illustrates this perspective, since the building
and their children, was the exposure of health workers to HIV of consensus related to health issues is facing interpretative
(FAUNDES, 2002). According to this article it can be seen ambiguities regarding the admission of women and men
that medical journals, medical societies and the legal sphere without partners and homosexual men and women to that
expressed opinion rigidly opposed to the sterility treatment in resource (DINIZ, 2006).
seropositive couples by 1996.
With the approval of assisted reproduction for seronegative Reproductive technologies and HIV/AIDS:
controversies of its inclusion in the public
people in 1997 by the International Federation of Gynecology
health system
and Obstetrics (IFGO), the reproduction centers now require
HIV testing for couples, but the legal recommendations, in The current development of assisted reproductive
particular, indicated that doctors would reserve the right to technologies in addition to a number of factors related to
the HIV/AIDS context makes up a scenario that potentially
refuse treatment in assisted reproduction in these cases.
includes the reproduction among seropositive people. Among
Faúndes (2002) recalls the resolution of the Federal Council
these elements, the highlights are the production of more
of Medicine from 1992, to give the assisted reproduction,
effective drugs, the success of the policy of free and universal
since that the effective probability of success exists and distribution of antiretroviral drugs by the Health Ministry, the
do not incur a serious health risk to the patient or possible methods of controlling the risk of “vertical transmission”
descendant. of HIV/AIDS , and finally, the feminization of the epidemic

7
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

itself, since women of reproductive age are now the key multiple pregnancy (triplets or quadruplets) in low income
stakeholders of the AIDS epidemic (KNAUTH et al., 2002; couples and the complications of this kind of childbirth.
MAKSUD, 2002, 2007, 2009). Concerns about the availability of genetic testing are also
However, the controversies on the assisted reproduction highlighted, since abortion - prohibited by law - in case of the
and AIDS subject are not few. On one hand, there is the diagnosis of genetic disease, could be triggered.
demand of social movements and political will of technicians As for the readers of the newspapers referred to in this
with an engagement history in health reform and the news, those who were against the program for health care
construction of a public health system committed to the rights to infertile couples with low incomes are mentioned. The
of the people. On the other hand, there are arguments about allegations focus on poverty and birth control issue: “why
whether assisted reproduction is a right, should it be funded to give birth to another poor in this country?”; “it would be
by State and what the priority of spending for AIDS policies. more appropriate to replace the word fertilization by the birth
In 2005, when the federal government constituted a control” and, still, there is mention to a reader who called
workgroup to draft a proposal for assistance on medically the proposal unnecessary and populist (BOLETIM..., 2005;
assisted reproduction for serodiscordant, seroconcordant and VARGAS, 2006). This is a clear example of causal relationship,
infertile couples, a news story (FOLHA..., 2005) illustrated present in the media, between fertility and poverty, based
the polemic. The news mention the reproduction as a right on the perception of demand for fertility regulation among
guaranteed by the Constitution, but opposes its viability in popular groups.
the public health system, claiming that there are measures This reductionist thinking, which often leads to the crime/
considered more urgent to be taken by the National Program poverty relation (HEILBORN, 2004), persists in spite of the
of STD/AIDS to control the epidemic. Examples of such results of a research, which inform the contrary: the Brazilian
measures are prevention programs and the production of raw demographic profile is close to the European countries profile
materials for manufacturing the anti-retrovirals. (BERQUO et al., 2004). Likewise, if one considers the kind of
In addition to these priorities, the news hint at problems thinking, the infertility problems were excluded as a relevance
arising from lack of information from the government, about topic to poor women. It is easy to suppose that this thinking
the demand for this type of procedure due to underreporting extends to disease situations, like AIDS, in these groups. This
of cases and, consequently, the high cost of reproductive view fails to consider the cultural meanings of motherhood
technologies. The reproduction technique used for seropositive for Brazilian society, especially for people participating in what
men to become father would be the most expensive assisted is known, ideally from popular segments (HEILBORN et al.,
reproduction, amounting to four times the cost of artificial 1997; MAKSUD, 2002, 2007; VARGAS, 1999).
insemination. The news said the high costs, coupled with a The voice of the assisted reproduction experts also
high number of seropositive people in Brazil and also to the speaks in favor of including treatments in SUS. Such
high estimate of unknown cases of people living with the virus, demands converged between users and experts are based
are the alleged reasons for the restrictions on the proposition on a concept of right to health as a universal principle, as
of universal right of reproduction provided in the constitution: it is conceived as “for all” and as “the duty of the state”.
If the door to assisted reproduction is opened, everyone will However, it is notable that there are different logics governing
have the right to the technical skills (FOLHA..., 2005). the distribution of resources allocated to health, in particular,
As for the health system in Brazil, the disclosure of the focused on reproduction. While recognizing the progress of
inclusion of assisted fertilization procedures in SUS expresses the actions of contraception that are considered example of
opinions that put under scrutiny the universal access to the implementation of reproductive rights in the country, the
it by various social groups, among others, those with low predominant use of female contraceptive methods in relation
income. An article on the subject of Reproductive Health in to the male shows gender inequality and the female body
the News Bulletin (BOLETIM..., 2005), reports that among becomes the privileged locus of medical interventions.
the technicians working in public health policies, the opinions It should be highlighted a contrasting difference between
favorable to the inclusion of reproductive technologies rely the investment in resources required for provision of
on the fight against birth control, which hooks up to assisted contraception to couples who need them and those required
reproduction to the more favored strata of the population. by the development of medical technologies for reproduction.
The positions contrary to the offering of IVF in SUS raise Resources for assisted reproduction are more bulky and
questions about issues relating to health, as the possibility of indicate, in addition to economic aspects, gender and class

8
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

differences (VARGAS, 2006; VARGAS et al. 2007). It also Final Considerations

stands out, even with respect to resources devoted to the
This paper presented a preliminary discussion on
design, expanding its market as a free service offering and
reproductive rights, assisted reproduction and HIV/AIDS.
medical procedures - considering the characteristics of the
“Reproductive rights” is a polysemic term, which is directed
health system in Brazil, that differentiates private and public
towards an extensive bibliography. For certain kind of feminist
service - which determines partially their ways of consumption
inspiration, this notion has a broad social-political meaning,
by those with greater purchasing power.
which involves the questioning of gender relations within the
In the case of assisted reproduction for HIV/AIDS, their
family and the guidance of family planning policies. At the
high costs usually afforded by middle and upper classes are
origin of the concept, there are founding ideas of contemporary
inversely proportional to the epidemiological profile of HIV/
feminism, as the right to their own body based on the
AIDS in Brazil, which is a free process of pauperization and,
principles of autonomy and freedom (our bodies belong to
consequently, reaches a contingent of Brazilian population with
us) (ARILHA, 2001; CORRÊA et al., 2003; SCAVONE, 2000).
poor material conditions of existence. Notably, researchers
A preliminary review of the literature in the field of
and managers have questioned the practice of alternative
public health stated that the articles focused on the debate
ways of having children, such as adoption, recalling it, even as
on contraception actions that constitute an example of the
an alternative to reproduction .
implementation of sexual and reproductive rights in Brazil
The extensive literature on reproductive technologies
prevail. In this direction, it is worth noting that such analysis is
(CORRÊA, 1998, 2001; LUNA, 2004; NOVAES et al., 1995;
structured around the family planning activities in the context
RAMÍREZ-GÁLVEZ, 2003; STOLCKE, 1998; TAMANINI, 2003),
of public health policies.
whose production has been highlighted by the authors as
Unlike what occurs with other types of assisted
a new field of studies (GROSS et al., 2003), also includes
reproduction, the sperm washing does not aim to remedy tout
issues relating to the control and regulation of bodies for
court infertility, but to allow a free flow of fertility considered
medical actions in a critical perspective from feminism. The
risky. This issue recalls the discussion of the types of problems
uses and abuses of modern technology in health have been
that the reproductive technologies would be solving (DINIZ,
considered, in this perspective, a serious health problem,
2006) and states the question (already raised by other
because of its association with high incidence of cesarean
authors): Who has the right to assisted reproduction? The
deliveries and surgical contraception, which makes Brazil a
public debate on assisted reproduction questioned whether
unique case in the international scenario (BERQUO, 1993).
the State should afford the costs of the use of reproductive
Specifically in relation to medical intervention in
technologies and whether there should be federal public
reproduction, the feminist-inspired studies discuss the risks
policies for that (DINIZ et al., 2002). It should be noted
of technological effects on health by correlating the lack of
that the demand for reproductive technologies in the SUS
information and women’s access to health services. These are
emphasizes not only economic, but issues of class, gender,
considered factors that limit the freedom of choice of women
sexual orientation, and others pertaining to the identities
(LABORIE, 1993; COREA, 1996; SILVA, 1996a, 1996b).
and affiliations relating to the marital union and the family
However, complaints about the consumption of medical
organization .
resources with focus on iatrogenic potential and the
The discourse on rights relating to the desire to have
explanations that restrict the use of reproductive technologies to
children in the context of reproductive medicine, can produce
the health risks seem insufficient to understand the seemingly
moralizing stories, raise questions for the fields of reproductive
contradictory attitudes of women and men in relation to
rights and reproductive health. In this direction, it is worth
reproductive, contraceptive or conceptive (LUNA, 2004). The
analyzing the reinterpretation of the discourses on moral
so-called alliance of women with medicine concerns broader rights and opportunities that are put into the course, since,
cultural processes relating to recovery of fertility in definite potentially moralizing narratives are also involved the outline
historical periods, making necessary the analysis of different and construction of new moralizing standards. As suggested
contexts that make its constitution possible. by Vianna and Lacerda (2004), this idea may be relevant in
Considering the effect that the topic on human two ways: by making the contours of political action more
reproduction issues nowadays and the attempts at regulation complex; and by highlighting the need for relativization of the
(legal and medical) for the use of technological innovations in uses and appropriations of the discourse on rights in different
this field, it should spell out the different logics that govern the fields, thus emphasizing the arguments placed in service to
behavior in the exercise of sexuality and reproduction. his defense.

9
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

Endnotes the procedures by exclusion criteria, based on social values prevalent

in Brazilian society.
1. This work integrates the research “Gender relations, reproduction
and HIV/AIDS: an analysis of views on assisted reproduction from
different stakeholders in the formulation and implementation of References
public policies in the field of sexual and reproductive rights” (funded
by CNPq, MCT Call/ CNPq/ SPM-PR/ MDA Nr 57/2008) approved AGÊNCIA BRASIL. Mulheres com dificuldade para
by the Ethics Committee of Fiocruz (protocol Nr. 500/08) and binds engravidar terão tratamento gratuito: anuncia
to the research lines of the IOC/Fiocruz, the Department of Health Humberto Costa. 2005. Disponível em: <http://agenciabrasil.
Planning of UFF and the Federal Rural University of Rio de Janeiro.
ebc.com.br>. Acesso em: 30 jun. 2005.
2. Generally the treatments for women at the time of prenatal care
are not intended for prevention, in cases where there is a desire to
AQUINO, E.M.L. Gênero e saúde: perfil e tendências da
become pregnant. produção científica no Brasil. Revista de Saúde Pública,
v.40, ne, p.121-132, 2006.
3. One of the authors of this proposal participated twice in this WG.

4. Taking into consideration the variety of factors that influence the

ARILHA, M. Políticas públicas de saúde, mulheres e
virus transmission in sexual relations, the author draws attention to DSTs/AIDS: reajustando o olhar. Rio de Janeiro: ABIA, 2001.
HIV transmission to women, this is due to its presence in semen, 19 p. (Coleção ABIA. Saúde Sexual e Reprodutiva, 4).
which is composed of sperm, seminal fluid (seminal vesicle and
prostate) and non-sperm cells (leukocytes). HIV is not present in all
BARBOSA, R.M.; LAGO, T.G. AIDS e direitos reprodutivos:
semen, but in the seminal fluid and non-sperm cells. para além da transmissão vertical. In: PARKER, R. Políticas,
instituições e aids: enfrentando a epidemia no Brasil. Rio
5. This technique was developed in Italy. In Brazil it is restricted to
couples who have higher income, being conducted by some private
de Janeiro: Jorge Zahar, 1997.
Human Reproduction clinics (FAUNDES, 2002). BERQUÓ, E.S.; CAVENAGHI, S. Mapeamento sócio-econômico
6. However, one has to ask whether, given this technology, the social e demográfico dos regimes de fecundidade no Brasil e sua
risk ceases to be outstanding, compared to the fact of coexistence variação entre 1991 e 2000. ENCONTRO NACIONAL DE
between two people as socially different (serodiscordant couples). ESTUDOS POPULACIONAIS 14, 2004, Caxambu. Anais...
That seems to be one of the most difficult to investigate because,
Caxambu: ABEP, 2004. p.1-18.
if there are still a large gap with respect to ethnographic work on
women using assisted reproduction (DINIZ and BUGLIONI, 2002), BOLETIM SAÚDE REPRODUTIVA NA IMPRENSA, fev. 2005.
there are also no studies on serodiscordant couples (MAKSUD, 2007; Disponível em: <http://www.redesaude.org.br/>. Acesso
MAKSUD, 2009) and particularly on the male desire to be father. em: 08 mar. 2005.
7. Infertility is a medical term that refers to changes regarding
BRASIL. Boletim Epidemiológico AIDS, Brasília, n.1, jun.
the operation of bodies, more specifically, the male and female
2007.
reproductive organs. Addressing the current desire to have children
- when it comes to non-reproduction through the desire to have BRASIL. Política prevê atenção integral. 2005. Disponível
children - implies, to contemporary society, necessarily to refer to
em: <www.aids.gov.br>. Acesso em: out. 2008a.
medical technologies available for reproduction as a way of modern
conception, due to the advancement of technology development BRASIL. Portaria n. 426, de 22 de março de 2005. Diário
and its growing popularity among different social groups (VARGAS, Oficial da União, 2005.
2006). In an extended concept, the term infertility can encompass, in
addition to clinical causes, psychological and social causes (CORRÊA, CODES, J.S. et al. Detecção de doenças sexualmente
2001; DINIZ, 2006). transmissíveis em clínica de planejamento familiar da rede

8. Perinatal transmission: mother to child at birth.

pública no Brasil. Revista Brasileira de Ginecologia e
Obstetrícia, v.24, n.2, p.101-106, 2002.
9. This suggestion was present several times in discussions of the
Workgroup of the Ministry of Health, discussed above. COREA, G. Os riscos da fertilização in vitro. In: SCAVONE,
10. The claim of homosexual paternity (UZIEL, 2007; TARNOVSKI, L. (Org.). Tecnologias reprodutivas: gênero e ciência.
2004; MOAS, 2006) exemplifies how the current desire of having São Paulo: Editora da Universidade Estadual Paulista, 1996.
children is configured related to marital, homoparenthood and gay and p.163-166.
lesbian identities (GROSSI et al. 2007; MELLO, 2005). The demand
for access to assisted reproduction by lesbian women is based on the
CORRÊA, M.V. Novas tecnologias reprodutivas: bem-vindas
logic of natural filiation and birth, that is, the choice of having a child reflexões feministas. Estudos Feministas, v.6, n.1, p.126-
in the biological dimension. These issues often determine access to 137, 1998.

10
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

CORRÊA, M.V. Novas tecnologias reprodutivas: limites KNAUTH, D.R. et al. Cultura médica e decisões reprodutivas
da biologia ou biologia sem limites. Rio de Janeiro: EdUERJ, entre mulheres infectadas pelo vírus da AIDS. Interface:
2001. Comunicação, Saúde, Educação, v.6, n.11, p.39-54,
2002.
CORRÊA, S.; ÁVILA, M.B. Direitos sexuais e reprodutivos: pauta
global e percursos brasileiros. In: BERQUÓ, E. (Org.). Sexo e LABORIE, F. Novas tecnologias da reprodução: risco ou
vida: panorama da saúde reprodutiva no Brasil. Campinas, liberdade para as mulheres? Estudos Feministas, Rio de
SP: Editora da Unicamp, 2003. p.17-78. Janeiro, v.1, n.2, p.435-449, 1993.

DIAZ, M. et al. Outcomes of three different models for sex LUNA, N. Provetas e clones: teorias da concepção, pessoa
education and citizenship programs concerning knowledge, e parentesco nas novas tecnologias reprodutivas. 2004. Tese
attitudes, and behavior of Brazilian adolescents. Cadernos (Doutorado) – Universidade Federal do Rio de Janeiro, Museu
de Saúde Pública, v.21, n.2, p.589-597, 2005. Nacional, Rio de Janeirok, 2004.

DINIZ, D.; BUGLIONE, S. Quem pode ter acesso às MAKSUD, I. O discurso da prevenção da Aids frente às lógicas
tecnologias reprodutivas: diferentes perspectivas do sexuais de casais sorodiscordantes: sobre normas e práticas.
direito brasileiro. Brasília: Letras Livres, 2002. Physis, v.19, n.2, p.349-369, 2009.

MAKSUD, I. Casais sorodiscordantes: conjugalidade,

DINIZ, D. Tecnologias reprodutivas no debate legislativo.
práticas sexuais e HIV/AIDS. 2007. Tese (Doutorado) –
MultiCiência: revista interdisciplinar dos centros e núcleos
Universidade do Estado do Rio de Janeiro, Instituto de
da Unicamp, n.6, 2006.
Medicina Social, Programa de Pós-graduação em Saúde
FAÚNDES, D. Reprodução assistida e HIV/AIDS. In: MAKSUD, Coletiva, Rio de Janeiro, 2007.
I. Conjugalidade e AIDS: a questão da sorodiscordância e
MAKSUD, I. Casais sorodiscordantes: questões iniciais para o
os serviços de saúde. Rio de Janeiro: ABIA, 2002.
debate. In: MAKSUD, I. Conjugalidade e AIDS: a questão
FOLHA ONLINE. Campinas faz fertilização com sêmen da sorodiscordância e os serviços de saúde. Rio de Janeiro:
purificado de portador do HIV. 29 jul. 2001. Disponível ABIA, 2002.
em: <http://www.uol.com.br/folha/equilíbrio/noticias>.
MELLO, L. Novas famílias: conjugalidade homossexual no
Acesso em: 20 out. 2001
Brasil contemporâneo. Rio de Janeiro: Garamond, 2005.
FOLHA DE SÂO PAULO. SUS vai oferecer fertilização. MINISTÉRIO DA SAÚDE. Programa mais saúde: direito
São Paulo, 3 mar.2005. Cotidiano. de todos. Disponível em: <http://bvsms.saude.gov.br/bvs/
pacsaude/estrutura1.php>. Acesso em: out. 2008a
GRINSTEJN, B. Prevenção da transmissão vertical. In: MAKSUD,
I. Conjugalidade e AIDS: a questão da sorodiscordância e MINISTÉRIO DA SAÚDE. Programa Nacional de DST/
os serviços de saúde. Rio de Janeiro: ABIA, 2002. AIDS. 2005. Disponível em: <http://www.aids.gov.br>.
Acesso em: out. 2008b.
GROSSI, M.; UZIEL, A.P.; MELLO, L. (Orgs.). Conjugalidades,
MOÁS, L.C. O reconhecimento jurídico da família
parentalidades e identidades lésbicas, gays e
homoafetiva: uma questão de justiça. 2006. Tese
travestis. Rio de Janeiro: Garamond, 2007.
(Doutorado) – Universidade do Estado do Rio de Janeiro,
HASSEN, M.N.A. Grupos focais de intervenção no projeto Instituto de Medicina Social, Rio de Janeiro, 2006.
Sexualidade e Reprodução. Horizontes Antropológicos,
NOVAES, S.; SALEM, T. Recontextualizando o embrião.
v.8, n.17, p.159-177, 2002.
Estudos Feministas, n.1, 1995.
HEILBORN, M.L.; GOUVEIA, P. Marido é tudo igual: mulheres
PAIVA, V. Sobre o direito ao amor: a sexualidade e a
populares e sexualidade no contexto da Aids. In: BARBOSA, vontade de ter filhos entre pessoas vivendo com HIV. 2007.
R.M.; PARKER, R. (Orgs.). Sexualidades pelo avesso: Tese (Livre-docência) – Universidade de São Paulo, São
direitos, identidades e poder. Rio de Janeiro: UERJ, 1999. Paulo, 2007.
p.49-72.
PAIVA, V. et al. Sem direito de amar?: a vontade de ter filhos
HEILBORN, M.L. Uma rota perigosa. O Globo, Rio de Janeiro, entre homens (e mulheres) vivendo com o HIV. Psicologia
07 out. 2004. Opinião, p.7. USP, v.13, n.2, p.105-133, 2002a.

11
 RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.5, p.3-12, Dec., 2010

PAIVA, V.; PERES, C.; BLESSA, C. Jovens e adolescentes em TAMANINI, M. Novas tecnologias reprodutivas
tempos de Aids: reflexões sobre uma década de trabalho de conceptivas à luz da bioética e das teorias de
prevenção. Psicologia USP, v.13, n.1, p.55-78, 2002b. gênero: casais e médic@s no Sul do Brasil. 2003. 363f.
Tese (Doutorado Interdisciplinar em Ciências Humanas) –
PERES, C.A. et al. Prevenção da Aids com adolescentes
Universidade Federal de Santa Catarina, Florianópolis, 2003.
encarcerados em São Paulo, SP. Revista de Saúde
Pública, v.36, n.4, supl., p.76-81, 2002. TARNOVSKI, L.F. Pai é tudo igual?: significados da maternidade
para homens que se autodefinem como homossexuais. In:
PIQUOT, C. La construction sociale de la parentalité dans
PISCITELLI, A.; GREGORI, M.F.; CARRARA, S. Sexualidade e
les cas d’insémination artificielle avec donneur. Mana, v.3,
saberes: convenções e fronteiras. Rio de Janeiro: Garamond,
1997.
2004.
RAMÍREZ-GÁLVEZ, M.C. Novas tecnologias reprodutivas
UZIEL, A.P. Homossexualidade e adoção. Rio de Janeiro:
conceptivas: fabricando a vida, fabricando o futuro. 2003.
Garamond, 2007.
259f. Tese (Doutorado em Ciências Sociais) – Instituto de
Filosofia e Ciências Humanas, Universidade Estadual de VARGAS, E.P.; RUSSO, J.A.; HEILBORN, M.L. Sexualidade e
Campinas, Campinas, 2003. reprodução: usos e valores relativos ao desejo de ter filhos
entre casais de camadas médias no Rio de Janeiro, Brasil.
ROHDEN, F. Ginecologia, gênero e sexualidade na ciência do Cadernos de Saúde Pública, v.26, n.1, p.153-162, 2010.
século XIX. Horizontes Antropológicos, Porto Alegre, n.17,
VARGAS, E.P.; RUSSO, J.; HEILBORN, M.L. Infertilidade e gênero
p.101-125, 2002.
entre casais de camadas médias no Rio de Janeiro. Interseções,
SALEM, T. Sobre o “casal grávido”: incursão em um v.9, p.15-30, 2007.
universo ético. 1987. Tese (Doutorado em Antropologia
VARGAS, E.P. Casais inférteis: usos e valores do desejo de ter
Social) – Museu Nacional da Universidade Federal do Rio de
filhos entre casais de camadas médias no Rio de Janeiro. 2006.
Janeiro, Rio de Janeiro, 1987.
Tese (Doutorado em Saúde Coletiva) – IMSUERJ, Rio de Janeiro,
SANTOS, N.J.S. et al. Mulheres HIV positivas, reprodução e 2006.
sexualidade. Revista de Saúde Pública, v.36, n.4, supl.,
VARGAS, E.P. A figueira do inferno: os reveses da identidade
p.12-23, 2002.
feminina. Revista Estudos Feministas, Florianópolis, v.7,
SAUER, M. Providing fertility care to those with HIV: time to 1999.
re-examine healthcare policy. The American Journal of
VENTURA, M.; CORREA, S. Adolescência, sexualidade e reprodução:
Bioethics, v. 3, n. 1, Mit Press, 2003.
construções culturais, controvérsias normativas, alternativas
SCAVONE, L. Direitos reprodutivos, políticas de saúde e interpretativas. Cadernos de Saúde Pública, v.22, n.7, p.1505-
gênero. Estudos de Sociologia, Araraquara, n.9, p.141- 1509, 2006.
158, 2000.
VIANNA, A.; LACERDA, P. Direitos e políticas sexuais no
SILVA, M.A. Infertilidade, práticas conceptivas e políticas Brasil: o panorama atual. Rio de Janeiro: CEPESC, 2004. (Coleção
públicas: entre desejos e direitos. In: PARKER, R.; BARBOSA, Documentos, 1).
R.M. (Orgs.). Sexualidades  brasileiras. Rio de Janeiro:
WILLELA, W.; MONTEIRO, S.; VARGAS, E. A incorporação de novos
Relume Dumará, 1996.
temas e saberes nos estudos em Saúde Coletiva: o caso do uso
SILVA, W.A. et al. Prevenção de doenças sexualmente da categoria gênero. Ciências e Saúde Coletiva, v.14, n.4,
transmissíveis e Aids entre jogadores juniores. Revista de p.997-1006, 2009.
Saúde Pública, v.36, n.4, supl., p.68-75, 2002.
VILLELA, W.; MONTEIRO, S.; VARGAS, E. A incorporação de novos
STOLKE, V. El Sexo de la biotechnology. Estudos temas e saberes nos estudos em saúde coletiva: o caso do uso da
Feministas, Rio de Janeiro, v.6, n.1, p.139-155, 1998. categoria gênero. Ciências e Saúde Coletiva, v.14, n.4, 2009.

12