HIV and Contraceptives

The World Health Organization recently released updated guidelines on the use of hormonal contraceptives for women with HIV and women whose sexual partners have HIV. These updated guidelines are a response to several studies which have found evidence that some hormonal contraceptives may increase a woman’s risk of being infected, or infecting someone else, with HIV.

What the Studies Say

At least half a dozen studies, and probably more, have examined the possible link between increased risk of HIV infection and contraceptives. The results of these studies vary wildly, and there is not enough solid information to prove or disprove a connection. These studies have left us with a number of questions and not many facts.

First off, the one definitive fact is that the possible increased risk of HIV transmission is only associated with progesterone-only forms of birth control, either pill or injection. No other form of hormonal or non-hormonal birth control has shown any risk or possibility of risk. The possible risk from the mini-pill is very small. So the only form of birth control that has any real chance of increasing your risk of getting or transmitting HIV is the progesterone only injection. If you are worried about getting infected and using a progesterone injection, be extra careful in your condom use and talk with your doctor about switching to a different birth control method. If you aren’t using a progesterone only injection, there is no reason to believe you need to worry about your birth control making you vulnerable to HIV.

Next, the risk, if it exists, goes both ways. A man who has sex with a woman who is HIV+ and on progesterone only birth control maybe at increased risk of being infected, and a woman on progesterone only birth control whose partner is HIV+ is also at increased risk of being infected.

The largest study, involving over 3000 people, had participants self-reporting birth control use and condom use. It also did not include information on specific brands or birth control. This means that there is a risk of inaccuracy in the study results, if the participants did not give correct information about their birth control and condom use, and that it is impossible to know if a specific brand of progesterone only injection, rather than all progesterone only injections, is causing an increased risk.

If there is an increased risk, it is possible that it is due to people being less careful with condoms when the woman is on long-term birth control.

Over all, facts are pretty slim on the ground.

What is WHO saying?

The World Health Organization’s main comment on these studies is that they are inconclusive. The existing evidence is too contradictory for any clear decision to be made. They have called for more studies to determine if there is a risk and if so how great the risk is.

In the mean time, WHO made 6 recommendations:

For women at risk of HIV infection

  • That they should be able to use any and all forms of contraceptive without restrictions
  • That they have ready access to condoms
  • That women using progesterone only injections make extra sure to use condoms in all sexual encounters, and make sure they know how to use condoms effectively
For women who are HIV positive
  • That they should be able to use any and all forms of contraceptive without restrictions
  • That they use condoms to prevent transmission of HIV to their partners
  • That for HIV+ women who do not want children, voluntary contraception is an important part of preventing mother-to-child transmission of HIV

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