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HIV 7 – Contraception

Integration of HIV treatment services and family planning is of paramount importance. Women living with HIV should have access to comprehensive information to assist them in making an informed, voluntary choice of a contraceptive method.1a,b

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Family planning and contraception for women living with HIV

Contraception is recommended for all women living with HIV who are able to become pregnant but do not currently wish to be.1c Women who do not currently desire to become pregnant should be provided with a choice of contraceptive options.1d,2a

Methods of contraception include:1e

  • BARRIER METHODS block sperm from reaching an egg3a

        Condoms (male and female)

  • SHORT-ACTING HORMONAL METHODS interfere with ovulation, fertilisation or implantation of a fertilised egg3b

        Oral Contraceptives

        Injection

  • LONG-ACTING REVERSIBLE HORMONAL METHODS stop ovulation, fertilisation or implantation of a fertilised egg3c

        Intrauterine Contraceptive Devices (IUCDs)

        Implant

  • EMERGENCY CONTRACEPTION can be used after unprotected sex or when another form of contraception fails3d

        Emergency pill or IUD

  • STERILISATION suitable for a woman with no desire for a child now or in the future.2b

        Sterilisation (male or female)

Contraceptive choices, however, are often influenced directly or indirectly by social, economic, and cultural factors.1b

Regardless of what method was chosen for pregnancy prevention, all women at risk or living with HIV should be strongly encouraged to use condoms consistently and correctly.2c

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Prevention of pregnancy – a partnership

The health and co-operation of both partners is important for safe contraception.1e The contraceptive choice depends on if or when the woman may want to fall pregnant in the future.1f If a woman does fall pregnant, she and her partner should continue using condoms consistently during pregnancy and the breastfeeding period.1g

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The ‘dual method’

A dual method of contraception is strongly recommended that all women living with HIV who wish to avoid pregnancy should consider a dual method of effective contraception – a contraceptive method of their choice plus consistent use of male or female condoms.1d,i

Dual methods are recommended and consist of:

  •  a hormonal method or IUCD to prevent pregnancy, and
  •  a barrier method (male/female condoms) to prevent STIs and HIV transmission1d

This will ensure prevention of pregnancy, prevent STIs and HIV transmission between partners.1i

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Additional protection

Additional HIV preventative measures such as voluntary adult male medical circumcision, awareness of one’s HIV status and reduction in number of sexual partners can also aid in the prevention of HIV transmision from partner to partner.1j,2c For more on preventative measures read further here: https://www.medinformer.co.za/health_subjects/hiv-6-preventing-hiv/

It is important to know that no contraceptive method provides protection against acquiring STIs and HIV.  Therefore consistent and correct condom use in addition to the chosen contraceptive method to prevent pregnancy is required.2f,g

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Are there any interactions between contraception and HIV medicines?

Generally, most forms of hormonal and long-acting reversible methods of contraception can be used by most women living with HIV.2d,e

There are some concerns that hormonal contraceptives may have reduced efficacy when combined with certain HIV medicines, e.g. if you are taking a regimen containing efavirenz, then an implant is not recommended.1h Always consult a health care professional to determine which contraceptive options is best for you and continue to use condoms correctly and consistently.1h

Speak to your doctor or pharmacist for further advice on your condition and the best treatment options for you.

Medical References

  1. National Consolidated Guidelines for the management of HIV in adults, adolescents, children and infants and prevention of mother-to-child transmission. South African National Department of Health, February 2020.
  2. National Contraception Clinical Guidelines, South African Department of Health, 2012.
  3. AIDSinfo Infographics. HIV and Birth Control [Last reviewed February 27, 2020]. Available from: https://aidsinfo.nih.gov/understanding-hiv-aids/infographics/4/hiv-and-birth-control Last accessed August 2020.
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