In the context of uncertainty, it is still possible to act. This means expanding method mix and weighing a possible clinical trial.
Right now, there are ongoing discussions about whether to conduct a randomized controlled trial to evaluate the impact of different family planning methods on HIV acquisition. Trial, known as ECHO, would add to the existing evidence base and is one part of a multi-pronged response that also includes clear communication and expansion of the range of options available to women today.
For an overview of advocacy positions on the proposed trial, known as ECHO, see:
Advocates Call for Full Funding of Research on HIV and Contraception, a September 2014 commentary by AIDS Legal Network South Africa, ATHENA Network, AVAC, International Community of Women Living with HIV/AIDS-East Africa, Pangaea Zimbabwe AIDS Trust and other advocates
ECHO Solidarity Statement from South African Advocates, A sign-on statement, addressed to South African political and public health leadership, to fully support the ECHO trial proposed to evaluate various contraceptive methods in relation to risk of HIV.
US Women & PrEP Working Group - Consensus Statement on ECHO Trial to NIH, launched October 1, this sign-on statement is anchored by organizations focused on reproductive health and HIV prevention for women of color in the United States—and highlights the relevance of ECHO to these communities.
Living with Uncertainty: Acting in the Best Interests of Women, authored by public health researchers and advocates Erica Gollub and Zena Stein, this article outlines an argument against a randomized controlled trial like ECHO, and makes five recommendations for moving forward in the context of existing data, including "scaling down" use of injectable hormonal contraceptives.
Hormonal Contraceptives and HIV Risk: Invest in a complex trial — A section of AVAC Report 2013: Research & Reality. The trial design has changed since this Report was published; however this excerpt contains background information and analysis that is relevant today.
For scientific background on the issue:
Hormonal Contraceptive Methods for Women at High Risk of HIV and Living with HIV: 2014 guidance statement — The most recent technical guidance from the World Health Organization, issued in July 2014 reviews the medical eligibility criteria for use of contraception, offering guidance on the safety of use of different methods for women and men with specific characteristics or known medical conditions.
Hormonal Contraceptive Methods and Risk of HIV Acquisition in Women: A systematic review of epidemiological evidence — A comprehensive review published in the journal Contraception in 2014 by Chelsea B. Polis, Sharon J. Phillips, Kathryn M. Curtis, Daniel J. Westreich, Petrus S. Steyn, Elizabeth Raymond, Philip Hannaford, Abigail Norris Turner
Use of Injectable Contraceptives and HIV Acquisition: The data to date — A figure summarizing the findings from key high-quality studies as of 2013.
Video of Helen Rees on HIV Risk and Contraceptive Use: An April 2012 video of Dr. Helen Rees, Executive Director of Wits Reproductive Health and HIV Institute, speaking on HIV risk and contraceptive use at the Microbicides 2012 Conference in Sydney, Australia
Additional background documents:
African Women's Civil Society Consultation on HIV Risk and Hormonal Contraceptive Meeting Summary
More than 40 women representing HIV prevention advocates, reproductive health service providers, and women living with HIV from Kenya, South Africa, Rwanda, Uganda and Zimbabwe met to review and discuss the existing data on hormonal contraceptive use and HIV risk.
Collaborative Statement from Women's Health Advocates
ATHENA Network, January 2012
This is a collaborative statement from women's health advocates from a WHO and partners stakeholders' meeting on hormonal contraception and HIV that took place in Geneva.