This article is more than 5 years old. Information may no longer be current.
WHO: Women can use any reversible contraceptive without increased HIV risk
Click Here to Manage Email Alerts
WHO revised its recommendations on hormonal contraceptive use to say that women at high risk for HIV can use any form of reversible contraception — including implants, intrauterine devices and progestogen-only injectables — without an increased risk for infection.
“Evidence shows that a woman’s risk of HIV should not restrict her contraceptive choice,” Peter Salama, MBBS, MPH, WHO executive director for universal health coverage, said in a news release. “All women should have access to a wide range of options for contraception, as well as to HIV prevention and to treatment, if needed.”
The decision is largely based on the results of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study, a randomized clinical trial that found no substantial difference in risk for HIV infection among women assigned to use the injectable progestin-only depot medroxyprogesterone acetate (DMPA-IM) compared with those assigned to use copper intrauterine devices or levonorgestrel implants.
Previous study findings had indicated that DMPA-IM may raise a woman’s risk for HIV. WHO said evidence from the ECHO trial “supersedes” the “low-moderate quality evidence” from past observational studies.
It noted that the guidelines continue to emphasize the importance of correct and consistent use of condoms when there is a risk for STIs, including HIV. The guidelines recommend pre-exposure prophylaxis (PrEP) for HIV prevention in settings where the incidence of HIV is more than 3%.
The ECHO study, which was conducted across four African countries, also revealed “concerningly high” levels of HIV and other STI acquisitions among women seeking contraceptive services, with a significant rate in younger women. The incidence was irrespective of the three contraceptive methods used.
“There is a clear need to ensure women in Africa have access to high-quality HIV and STI prevention and testing services, along with a wide range of contraceptive options to suit their values, preferences, views and concerns,” Felicitas Zawaira, MD, director of family and reproductive health in WHO’s African region, said in the release. “In high HIV prevalence settings, these may include condom promotion, PrEP, as well as linkages to antiretroviral therapy for those testing HIV-positive, and partner testing.” – by Joe Gramigna
Reference:
WHO. WHO revises recommendations on hormonal contraceptive use for women at high HIV risk. https://www.who.int/news-room/detail/29-08-2019-who-revises-recommendations-on-hormonal-contraceptive-use-for-women-at-high-hiv-risk. Accessed August 29, 2019.
Disclosures: Salama and Zawaira report no relevant financial disclosures.