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hormonal contraceptives and
HIV risk

Around the world, women, sexual and reproductive health advocates, service providers, researchers and other stakeholders are following the discussion of if and how hormonal contraceptive use affects HIV-negative women’s risk of acquiring or transmitting HIV, and how it might affect HIV-positive women too. In recent months, AVAC has worked with civil society stakeholders to convene various dialogues on this issue.

In depth resources on this subject are available below.

What's New

Facing Questions about Hormonal Contraceptives and HIV
In this call we learned about and discussed proposed research to directly evaluate how different family planning methods might impact HIV risk.

Trial designs are actively being discussed and funding is being sought for such research—but there are many questions where advocates' voices are needed: What should a trial look like? How can method mix (the range of available family planning options) be expanded for all women? What can be done to better integrate HIV and family planning in the meantime?

Animation: Flash
Audio: MP3
Slides: PDF

World Health Organization Statement
The World Health Organization (WHO) published a statement on a recent technical consultation on the use of hormonal contraceptives and HIV risk, and WHO recommendations around contraceptive use for women living with HIV/AIDS or at high risk of HIV. (Read the accompanying clarification note.) AVAC held a global teleconference to discuss the recommendations. Listen to a recording of this call.

In the statement, the WHO notes that experts at the consultation concluded that the WHO should continue to recommend that there are no restrictions on the use of any hormonal contraceptive method for women living with HIV or at high risk of HIV. However, they recommended that a new clarification be added for women using progestogen-only injectable contraception at high risk of HIV. They emphasized that women should also use condoms to prevent HIV acquisition and transmission. They also stressed the need for further research on the issue and the importance of offering a wider choice of contraceptive options. For a summary of the consultation proceedings, click here.

A global advocates' teleconference to discuss the WHO recommendations recently took place. It featured representatives from the WHO, UNAIDS, program implementers and civil society representatives who participated in the technical consultation. The bulk of the call will be devoted to a facilitated discussion on the WHO recommendations and what they mean for women and the programs that serve them.

Listen to the teleconference.

Background

In light of recent data suggesting the the use of hormonal contraceptives might double the risk of HIV transmission among women and their partners, the World Health Organization recently convened a stakeholder group to review the existing data and discuss what might go into a new guidance document.

The most recent data comes from two prospective studies of HIV incidence: the Partners in Prevention HSV/HIV Transmission Study and a separate observational study of couples enrolled at Partners' sites. Women using hormonal contraception, primarily injectable hormonal contraception, had a two-fold increase in risk of acquiring HIV. Women who were HIV-infected at the beginning of the study and using injectable contraception were also two times as likely to transmit the infection to their uninfected male partners and had higher genital HIV RNA concentrations.

Mixed Data
However, previous research on hormonal contraceptive use and risk of HIV transmission has been mixed. In 1991, Plummer et al. were the first to report an association between the risk of HIV-1 infection and oral contraceptive use. In 2004, Lavreys et al. analyzed data from a ten year prospective cohort study in Kenya and found that women using either injectable hormonal contraceptives or oral contraceptive pills were at increased risk of HIV-1 acquisition, and in 2009 Watson-Jones et al. also found some association between HIV incidence and exposure to hormonal contraceptives.

Yet, in 2007 Morrison et al. published results from a ten year prospective cohort conducted in the general population finding no association between hormonal contraceptive use and HIV acquisition overall. In 2009, Morrison et al. conducted a peer-reviewed literature review of prospective studies finding that the data they analyzed suggests that neither oral contraceptive pills nor injectable hormonal contraceptives increase the risk of HIV infection among women in the general population.

However, in 2010 Morrison et al. analyzed their 2007 results again using a different analytical method and found an association between injectable hormonal contraceptive use, a large association for young women in particular, and increased risk of HIV acquisition, but found no increased risk for oral hormonal contraceptive users.

All studies called for further research to be conducted to verify their findings.

Further Resources

Civil Society Consultations and Statements

Ugandan Service Provider Perspectives on the WHO Recommendations on Hormonal Contraceptives and HIV Risk
September 2012
AVAC Prevention Research Advocacy Fellow Lydia Mukombe presents on her advocacy on HCT-HIV with Ugandan service providers

No More "Stay the Course": Acting on Risks of DMPA for Women and Men
July 2012
Excerpted analysis of the data to date and the imperative to act by Erica Golub, Dr.PH and Zena Stein, M.A., M.B., B.Ch., Dr. Med. Sc. (hon)

Video of Helen Rees on HIV Risk and Contraceptive Use
April 2012
Dr. Helen Rees, Executive Director of Wits Reproductive Health and HIV Institute, speaks on HIV risk and contraceptive use at the Microbicides 2012 Conference in Sydney, Australia

Response to World Health Organization Guidelines
The International Community of Women Living with HIV, February 2012
The ICW urgently demands the WHO to correct the Note for the Media, acknowledges the WHO Technical Statement on Hormonal Contraceptives and HIV with concern and caution, and demands greater communication and further research now.

The UN's Gag Order on Reproductive Health
AIDS-Free World, February 2012
A statement by AIDS-Free World Co-Director, Paula Donovan, on the confidentiality agreements prohibiting dicussion on hormonal contraceptive safety.

African Women's Civil Society Consultation on HIV Risk and Hormonal Contraceptive Meeting Summary
January 2012
On 25th January, 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.

Global Teleconference on Hormonal Contraceptives and HIVAVAC, October 2011
A global advocates’ teleconference took place to provide an opportunity for advocates, researchers and policy makers to discuss and ask questions about recently published data on the relationship between hormonal contraceptive use and risk of HIV infection.


Introductory Material

Issue Overview: Hormonal contraceptives and HIV-1 risk
AVAC, UPDATED April 2012
A short primer providing background, help understanding the issue and what happens now.

UNAIDS Q&A on Hormonal Contraceptives and HIV
UNAIDS, March 2012
UNAIDS released a frequently asked questions document on hormonal contraceptives and HIV.

Q&A - Hormonal Contraception and HIV
FHI 360, February 2012
FHI 360 assembled a short question and answer piece to help understand hormonal contracpetives and a potential increase in HIV risk acquisition.

Published Research and Editorials

Hormonal Contraception and HIV: an unanswered question
Lancet Infectious Diseases, October 2011
Charles Morrison and Kavita Nanda of FHI 360 offer a short overview of some of the relevant data, note the need for a better understanding of the relative risks and call for a randomized trial of hormonal contraception and HIV acquisition.

Hormonal Contraception and HIV: Weighing the evidence and balancing the risk
RH Reality Check, October 2011
This article looks at the limitations of the most recent study on the topic, discusses possible ways to conduct research designed to specifically examine these questions and considers how to balance the risks women face both from HIV and unintended pregnancy.

Hormonal Contraceptives and HIV Risk: Emerging Evidence in Context
Guttmacher Institute, October 2011
Provides additional commentary and background on this issue.


WHO and UNAIDS Technical Guidance and Other Documents

Medical Eligibility Criteria for Contraceptive Use
World Health Organization, 2009
This document 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.

Medical Eligibility Criteria Wheel for Contraceptive Use
World Health Organization, 2008
This wheel contains the medical eligibility criteria for starting use of contraceptive methods. It is based on the Medical Eligibility Criteria for Contraceptive Use, 3rd edition and its 2008 Update, one of WHO’s evidence-based guidelines.

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