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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

We could be just months away from knowing whether Depo-Provera use is linked to a higher risk of HIV infection in women.

November 23, 2018
Bhekisisa: Center for Health Journalism

As we commemorate this year’s World Contraceptives day (October 26th, 2018), let us take a look at the mystery that surrounds Depo and HIV.

September 27, 2018
New Vision

This article outlines a strategic action framework developed as an outcome of a series of expert meetings held between 2014 and 2016. The meetings focused on identifying opportunities and challenges for MPTs that combine hormonal contraception (HC) with antiretroviral drugs into single products.

September 24, 2018
The European Journal of Contraception & Reproductive Health

Women of reproductive age are disproportionately affected by HIV/AIDS globally, at risk for both unintended pregnancy and HIV infection. It stands to reason that both issues should be simultaneously addressed by governments, health care providers, advocates, and donors. A burgeoning partnership between the HIV/AIDS and family planning sectors led to a well-attended session at the International AIDS Conference in Amsterdam in late July.

August 30, 2018
Medium

The World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March 2017. The guideline development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from category 1 to category 2 for progestogen-only injectable contraceptives among women at high risk of HIV. The data that informed this decision are from observational studies, which have limitations; therefore, causality or association of hormonal contraception and risk of HIV acquisition have not been proven.

July 25, 2018
South African Medical Journal
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