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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

Our ECHO trial results page has press released, public statments, background on the trial, and lists opportunities to learn more, discuss the data and work with fellow advocates on what’s next.

June 13, 2019
AVAC
What We're Reading

We can now breathe a sigh of relief after science has confirmed that using South Africa’s most popular birth control Depot medroxyprogesterone acetate — commonly known as Depo Provera — doesn’t increase women’s risk of HIV infection.

June 16, 2019
Health-E

We did not find a substantial difference in HIV risk among the methods evaluated, and all methods were safe and highly effective. HIV incidence was high in this population of women seeking pregnancy prevention, emphasising the need for integration of HIV prevention within contraceptive services for African women. These results support continued and increased access to these three contraceptive methods.

June 13, 2019
Lancet

Although ECHO results are largely reassuring for contraceptive methods included in the trial, a substantial unfinished agenda remains to meet the range of needs of those at risk for unplanned pregnancy and HIV infection, including stronger global and national commitments and accountability for informed choice for family planning and HIV prevention and treatment. Many factors are driving unacceptably high rates of HIV acquisition in young women, but we have good reasons to believe that contraception is not one of them.

June 13, 2019
Lancet

Depo Provera does not increase HIV risk. But African women are still left with too few contraceptive choices.

June 13, 2019
Bhekisisa

The world has spent nearly a quarter of a century wondering whether Africa’s most widely used birth control method could make women more likely to contract HIV. Now, new research, conducted in four countries, including South Africa, has solved the riddle.

June 13, 2019
Bhekisisa

A landmark study has ended 30 years of anxiety that hormonal contraceptive injections may increase women’s chances of infection from HIV. But the study has also found a dramatically higher rate of HIV infection among women in southern Africa than was expected, which one leading campaigning organisation said signified “a public health crisis”, leading to calls for more efforts to protect them from the virus that leads to AIDS.

June 13, 2019
The Guardian
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