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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
AVAC
What We're Reading

Three quarters of women taking antiretroviral treatment (ART) and using hormonal contraception had a potential drug-drug interaction in a large Chicago trial, involving 317 women. The most frequent interacting hormonal contraceptives were the progestin intrauterine device (69%) and the combination oral tablet (23%), distantly followed by the progestin implant (4%), the vaginal ring (3%), and the estrogen patch (1.4%). The researchers categorized these as "potential interactions" and none as "do not coadminister."

October 4, 2017
ID Week 2017/IDSA

This article in Contraception summarizes key findings and conclusions from a December 2015 meeting convened by WHO on the research agenda for hormonal contraception and HIV.

May 30, 2017
Contraception

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
devex
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