I am angry. I know the best way to harness it is to shout from the rafters. The government of Namibia on June 10, 2009 hosted the HIV/AIDS Implementers meeting. Below is the article that started my ranting. Below the news article is the link to the press release of the HIV/AIDS meeting by the Namibian government. Let's get these issues into the spot light.

A few weeks after giving birth to a baby boy by Caesarian section, Hilma Nendongo went back to hospital to have the stitches removed. A nurse glanced at her medical record and casually asked her a horrifying question.

“Oh,” the nurse said, “did they tell you that you had been sterilized?”

Ms. Nendongo, a 30-year-old villager from northern Namibia who barely spoke English, tore through her personal health card, looking for a clue to what had been done to her in the state hospital.

She couldn't read any of the doctor's scrawled handwriting, except for the word “stop” and the word “closed.” She later discovered the sickening truth: this was a common code for a tubal ligation, the most frequent form of sterilization in Namibia.

She suddenly remembered that the hospital staff had told her to sign some papers as she entered the operating room for her C-section. Nobody had explained the papers.

“It was a very big shock,” she said, brushing back tears. “I was very emotional. I cried a lot. I wanted a sister for my three boys, and now I can't have one.”

She returned to the hospital to search for the doctor who had sterilized her. She hoped that somehow he could reverse the operation. But every time she went to the hospital, the staff said the doctor was busy or away.

Ms. Nendongo didn't know it at the time, but she was one of dozens of African women – perhaps hundreds – who have been sterilized without their knowledge or consent in recent years because they were HIV-positive. At least 20 such cases have been documented in Namibia, some occurring as recently as six months ago, and similar cases are believed to have occurred in Zambia, South Africa and Congo.

“ I feel for the other women who went through the operation. They've been violated. Something has been taken away from them. This is arrogance by the doctors.”

Women's groups say the coerced sterilizations are examples of the continuing stigma and discrimination suffered by African women who have the AIDS virus. Governments and doctors still sometimes see HIV-positive women as irresponsible dangers to society who must be restricted or even criminalized. Despite new medicine that allows them to live normally and have healthy children, many women are told they must not get pregnant. Two countries, Sierra Leone and Tanzania, even passed laws that criminalize the mother-to-child transmission of HIV.

Sterilization is an especially traumatic blow for village women in rural Africa, who endure humiliation and being ostracized if they cannot have children. Some childless women are even labelled “witches” who “ate their children” for witchcraft medicine.

Three years after her sterilization, Ms. Nendongo has still not dared to tell her mother about the operation. She told her boyfriend and he promptly deserted her.

“He said, ‘My dear friend, I will not stay with someone who cannot have children.' So I have no man and I have three children. No man wants me. In Africa, if you want a man, you have to be able to give him children.”

In remote rural districts, where women are often illiterate, many were sterilized without their knowledge, she believes. “It's because you are poor and you cannot demand your rights. You can't question a doctor. The doctor knows you can't report him – he is protected by the government. My doctor did it to me because I was HIV-positive and he thought I shouldn't have more children.”

Ms. Nendongo, who earns about $50 a month by selling Chinese herbal medicine in her community in northern Namibia, is still hoping that her sterilization can be reversed. But she cannot even afford the cost of a medical exam, unless she can get financial compensation through court action.

Lawsuits have been filed by the 20 Namibian women whose sterilizations have been documented most extensively. “I want the government to be held accountable,” she says. “The government destroyed our future.”

Another HIV-positive woman from a northern village, Karina Sagaria, was sterilized in 2007 at the same state hospital in Windhoek. After a routine test, she was told to return for an unspecified operation, and to bring blankets for an overnight stay.

A nurse told her to sign some papers. “I said, ‘What am I signing for?'“ she recalls. “They just said, ‘Just sign this and get on the bed. Shut up and sign.' So I signed.”

Ms. Sagaria, who is illiterate and painfully shy, could not read the writing on her health card. A few days after the operation, a nurse read her health card and explained what had happened. “You're sterilized and you can't have any more children,” the nurse told her.

Ms. Sagaria was stunned by the news. “I wanted to commit suicide,” she said. “To not give birth to another child – your life is ruined. I'm still in shock. I have a boyfriend and I want to get married, but I haven't told him. If I have to tell him, he will leave me and look for someone else who can have children.”

Ms. Sagaria, who is now 38, lives in a cattle-farming village where she takes care of her 16-year-old son and five other children who were orphaned in the village. She is hoping that the lawsuit will provide some compensation for what happened to her. “It was unfair,” she says. “It was because I'm poor and didn't know anything.”

An activist group, the International Community of Women Living with HIV/AIDS (known as ICW), is supporting the lawsuit by the sterilized women. Trial dates for the first six cases are due to be set next week.

We are still seeing new cases,' said Jennifer Gatsi-Mallet, a leader in Namibia with the International Community of Women Living with HIV/AIDS. 'Some women are scared to go to the hospital now because they’re afraid they will be sterilized. In Africa, if you can’t have children, it’s even worse than living with HIV. You must have children.'

Researchers at ICW believe the sterilizations were a result of secret government guidelines sent to the hospitals, based on outdated information about the risk of a pregnant woman transmitting the virus to her infant. The women's group has asked for new guidelines to be sent to the hospitals, but has seen no sign of it so far.

“A lot of this stems from really strange and rudimentary fears about HIV-positive women,” said Aziza Ahmed, a legal expert at ICW. “I think people want HIV-positive women to be punished in a way. There's that attitude that blames women for the spread of the virus.”

The Namibian government, in its response to the lawsuit, has argued that the women were informed of the operation and gave their consent by signing the forms. But most of the women say they were never told of the nature of the operation. The consent forms were brought to them when they were lying drugged on hospital beds or in operating theatres when they were about to give birth.

Even in cases when the operation was explained, the women say they were pressured into it. Some were told the operation was mandatory if they wanted to stay alive, or if they wanted medical assistance in delivering their baby.

“The doctor is always right – that's what we grow up with,” said 26-year-old Esther Sheehama, an HIV-positive woman in Windhoek who was sterilized without her knowledge in 2003. “They tell you to do something, and you do it.”

Ms. Sheehama remembers how a nurse asked her to sign two papers as she lay half-naked in a hospital bed, waiting to give birth to her first baby by C-section. Each document was several poorly photocopied pages, and she signed them without reading them, thinking they were somehow connected to the C-section. “I was nervous, scared, lying there hungry,” she remembers. “I just wanted to get it over and done with. It was horrible.”

A month later, at a check-up, a nurse asked whether she was on contraception, and then glanced at her health card. “No, there's no need for contraceptives,” the nurse told her. “You are closed.”

At first, Ms. Sheehama assumed there was a medical rule that any HIV-positive woman must be sterilized. “We didn't know much about HIV at the time,” she said.

But later she discovered that her son did not have the AIDS virus. Now he is five year old and healthy, and he often tells his mother that he wants a sister, like his friends at school. “I'm very, very angry,” she said. “Having children is my choice, not a doctor's choice. I want them to see that women have the right to their own bodies. Don't be a policeman over me.”

Saima Moses, 28, discovered that she had HIV in 2006 when she was pregnant. After giving birth, she was told to return for another procedure. She said the medical staff wrote “BTL” on her health card, but refused to explain what it was.

At the last minute, her operation was cancelled because of an electricity failure at the hospital. As she left the hospital, she finally persuaded a nurse to tell her what “BTL” meant. The nurse said it meant “Bilateral Tubal Ligation” – sterilization.

“I was this close to getting it,” Ms. Moses said. “I was so sad, I was crying. I didn't go out of the house for two weeks. I never went back to the hospital. I felt misled – I was so furious that I felt I might kill someone.”

She tore up her health card to ensure that the sterilization would never be carried out. Years later, when she visited the hospital to ask for her medical file, the staff said it was unavailable.

“I feel for the other women who went through the operation,” she said. “They've been violated. Something has been taken away from them. This is arrogance by the doctors. They shouldn't just take you into an operating theatre without telling you what they are doing. Sterilizations are still happening today and people don't know what's going on.”

The phrase “BTL” can be seen on the health cards of many women who have joined the lawsuit. But almost all of the 20 women in the lawsuit are from Windhoek, the capital, where the issue has gained attention. There may be many women in rural regions who are still unaware that they were sterilized.

“We are still seeing new cases,” said Jennifer Gatsi-Mallet, an ICW leader in Namibia.

“Some women are scared to go to the hospital now because they're afraid they will be sterilized. In Africa, if you can't have children, it's even worse than living with HIV. You must have children.”

With a report by Mara Kardas-Nelson in Cape Town

Here is the link to the HIV/AIDS Implementer Meeting hosted by the Namibian government; HIV/AIDS IMPLEMENTERS MEETING