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Hormonal Contraceptives and HIV

One woman has many choices, many needs. Family planning and HIV prevention must be integrated.

Many women at risk for HIV are equally, if not more, concerned about avoiding or postponing pregnancy. Some research suggests that specific injectable contraceptives (progestogen-only products like DMPA and Depo-Provera) increase women’s risk of acquiring HIV. There are other studies that do not show this link between DMPA and HIV risk. There is an ongoing global discussion about how to proceed with HIV prevention and family planning programs in the context of this uncertainty. There is an urgent need to ensure that women who want and need effective family planning methods are able to access them. Unplanned pregnancies carry a high risk of maternal mortality and morbidity. There is an equally compelling need to ensure that women receive full information about the risks and benefits of different methods—including potential HIV risk—and that they have access to a range of choices.

It is important to note that these data are of primary relevance to women living in southern and eastern Africa in countries with high HIV prevalence and incidence and high use of DMPA. In these settings, some countries, like South Africa, are already moving to update their contraceptive policies to reflect the uncertainty about progestogen-only contraceptives like Depo-Provera. There is also ongoing discussion about the kinds of research that could be conducted—from randomized trials to observational studies—to learn more about this key question.

In this context, it is critical that the voices and priorities of African women guide the conversation. AVAC works in partnership with groups and individuals in East and Southern Africa to prioritize and amplify womens’ issues and concerns.

Key Update

AVAC's sheet on the hormonal contraceptive known as Depo-Provera (DMPA) and the WHO grading system for contraceptives explains key issues in plain language. Research findings have raised questions about the safety and effectiveness of DMPA for women who face a high risk of HIV. WHO evaluates the safety and efficacy of contraceptive methods.

March 2, 2017
What We're Reading

A careful look at the implications of WHO’s revised guidance on progestogen-only injectable (widely used as the brand Depo-Provera), the most popular form of birth control in many HIV-burdened countries. This story touches on a range of issues: how providers will explain the ambiguous connection between HIV acquisition and progestogen-only injectables, the mandate to empower women with information, and the pressure to expand options for reproductive health for women in these countries.

April 4, 2017

In light of the WHO updated recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV, a diverse group of 80+ individuals and organizations representing women living with and affected by HIV in sub-Saharan Africa call for effective responses to the provision of hormonal contraceptives in the context of HIV, women's sexual and reproductive health and rights.

March 6, 2017
Civil Society Group

ECHO Researchers are updating their materials and counseling messages to inform all trial participants about the WHO’s tightened guidance on hormonal contraceptives and HIV risk. In this statement, ECHO leadership reiterates its commitment to fill information gaps on contraception and HIV risk in the service of expanding women’s rights to information and options.

March 3, 2017
ECHO Consortium
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