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Hormonal Contraceptives and HIV

One woman should have many choices to meet many needs. HIV prevention must be integrated with sexual and reproductive health.

Many women at risk for HIV are equally, if not more, concerned about avoiding or postponing pregnancy. Women urgently need access to information about contraceptives and HIV prevention, and they need expanded access to the full range of proven options for both.

In June 2019, results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study put these priorities sharply into focus. ECHO found no substantial difference in HIV risk among women using three methods of contraception – depot medroxyprogesterone acetate-intramuscular (DMPA-IM) also known as Depo-Provera, the copper intrauterine device (Cu-IUD), and a levonorgestrel (LNG) implant also known as Jadelle.

The findings from the ECHO study help to answer a decades-long question stemming from mixed data on past observational studies—some had suggested DMPA-IM might be associated with an increased risk of HIV, while others did not.

ECHO also showed high rates of HIV incidence — at nearly four percent — among the study population of women and adolescent girls age 16-35 in East and Southern Africa.

Taken together, these findings must spur action. The risk of HIV for women and girls remains alarmingly high, as do the risks to maternal health from unplanned pregnancies.

The ECHO trial provides important evidence to inform women’s choices, and to inform the integration of policies and programs for HIV and contraceptive services needed to support those choices. Access should be expanded to all proven HIV prevention options—including female condoms and daily oral PrEP—while continuing to invest in the development of new, women-controlled, HIV prevention options. In this context, the voices and priorities of African women must 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

The World Health Organization (WHO) released updated guidance on “Hormonal Contraceptive Eligibility for Women at High Risk of HIV”. We are gravely concerned that this guidance will be used to justify a “business as usual” approach in which contraceptive procurement, program design, service delivery and counseling approaches go unchanged.

August 29, 2019
AVAC
What We're Reading

Our ECHO trial results page has press releases, public statements, 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

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
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