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WHO Guidance Confirms Safety of Hormonal Contraception
for Women at Risk of HIV or Living with HIV

NEW YORK—February 17, 2012—The World Health Organization (WHO) convened a meeting of multidisciplinary experts from January 31 to February 1, 2012, to assess available evidence on the use of hormonal contraceptives and HIV acquisition, progression, and transmission. EngenderHealth also participated in the technical consultation in Geneva. WHO has concluded that women, including those at risk of or living with HIV, can safely continue to use hormonal contraceptives to prevent pregnancy.

EngenderHealth supports the WHO guidance (PDF, 174KB) and urges its staff and partners to follow the WHO’s Medical Eligibility Criteria for Contraceptive Use (MEC), which recommends no restrictions on the use of hormonal contraceptives for women at risk of HIV or living with HIV. WHO states that there is insufficient evidence of an association between hormonal contraceptive use and HIV risk to warrant any change in this guidance, but they strongly advise women at high risk of HIV who are using progestogen-only injectables to use condoms and other HIV preventive measures. Furthermore, WHO stresses the need for women and couples to have access to a wide range of contraceptive methods and for further research on the relationship between hormonal contraception and HIV to be undertaken.

This issue brings to light the stark reality faced by women living in places hit hardest by HIV and AIDS—they are at higher risk of contracting HIV and of dying from a pregnancy-related condition. In this situation, health care professionals must be trained and supported to counsel women effectively, so that clients are making informed choices and voluntary decisions about family planning and reproductive health. This is paramount.

With nearly 70 years of experience in ensuring clients’ rights and improving access to quality family planning and reproductive health services in more than 100 countries, EngenderHealth today, as always, emphasizes that clinical excellence, regardless of the setting, hinges on:

Ensuring women’s continued access to hormonal contraception and other methods of family planning. Hormonal contraceptives are highly effective methods and in fact are the most widely used contraceptives in Sub-Saharan Africa. Because the possibility of a link between hormonal contraceptives and HIV was widely covered in the media worldwide, women must be assured that their method of choice does not put them at undue risk of HIV—and that not using contraception poses the risk of an unplanned pregnancy, which carries another set of potential dangers. Indeed, the WHO guidance reinforces the message that hormonal contraceptives remain a viable family planning method for all women, including those at risk of or living with HIV, and that access to hormonal contraceptives must continue to preserve women’s health and well-being.

Keeping clients’ rights front and center. The ability for individuals to make informed choices and voluntary decisions, not only about family planning, but about all aspects of sexual and reproductive health, is a fundamental principle rooted in human rights and underpinning quality care. It means that a wide range of contraceptive methods is available and accessible—including long-acting and permanent options—and that women and couples are counseled about the known risks and benefits of each method. Promoting clients’ rights has always been a priority for EngenderHealth, and it remains so today. We believe that it is more important than ever to refocus attention and resources on making clients’ sexual and reproductive rights a reality by safeguarding the longstanding principle of informed choice and voluntary decision making.

Engaging men as partners in family planning and reproductive health. The WHO guidance stresses the need for women at high risk of HIV who also use hormonal injectables to use condoms to prevent HIV acquisition and transmission. Engaging men on the importance of sharing responsibilities for family planning and reproductive health—including encouraging them to use condoms for dual protection and to access health care services, including getting tested for HIV—is essential for preventing HIV infection and maintaining strong reproductive health.

Integrating family planning and HIV services for better care. Integrating basic health care services, including reproductive health and family planning services, is a vital strategy for providing quality, client-centered care, particularly in resource-poor environments. Because some 50–85% of women living with HIV do not want to become pregnant, ensuring access to voluntary, affordable, and appropriate contraceptive information and services can help women avoid unintended pregnancies and associated health risks, including the risk of vertical transmission. Much more can be done at the country level to make this a reality in both policy and practice.

Offering a range of family planning method choices. It is unfathomable that in 2012, women and couples do not have access to a wide choice of family planning methods—yet this is still the reality for millions of women and couples in the developing world. When a woman’s method of choice is unavailable, she is more likely to forgo contraception altogether. Women and couples have a right to choose among a wide variety of contraceptive methods and to use the method that best fits their individual needs and supports their sexual and reproductive health. Indeed, too many modern methods of contraception, including long-acting and permanent methods (LA/PMs), such as the intrauterine device (IUD), are vastly underutilized in Africa, even though women and couples who have decided to space and/or limit their families could benefit greatly from using them. This is why EngenderHealth has worked for decades and to expand contraceptive choice, including increasing access to LA/PMs.

 

For more information, please contact George Brown, MD, MPH, Senior Technical Advisor, at gbrown@engenderhealth.org, or Theresa Kim, Director of External Relations, at tkim@engenderhealth.org.

 
 

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