Should HIV+ Women be Concerned about Hormonal Contraceptives?

Alexander Sanger, Chair of the International Planned Parenthood Council

Recent evidence indicating that hormonal contraception may increase the risk of women acquiring and transmitting HIV has caught the eye of the World Health Organization (WHO). However, after a two-day convening to evaluate whether changes to its advice regarding HIV and the use of hormonal contraceptives would be needed, the group of 75 experts from 18 countries decided to leave WHO's guidelines as is and added the following statement of clarification:

"Some studies suggest that women using progestin-only injectable contraception may be at increased risk of HIV acquisition; other studies do not show this association. A WHO expert group reviewed all the available evidence and agreed that the data were not sufficiently conclusive to change current guidance. However, because of the inconclusive nature of the body of evidence on possible increased risk of HIV acquisition, women using progestin-only injectable contraception should be strongly advised to also always use condoms, male or female, and other HIV preventive measures. Expansion of contraceptive method mix and further research on the relationship between hormonal contraception and HIV infection is essential."

This statement was met with sharp criticism for not going further in warning and discouraging women from using hormonal contraception, particularly given that WHO believed the quality of the data it considered for this report to be low.

About half of the 34 million people in the world living with HIV are women. Girls and women have an increased vulnerability to HIV infection, in part because many lack control over common methods of HIV prevention. While a range of contraceptives can prevent unplanned pregnancies, only condoms can prevent the transmission of HIV.

In a press statement last week, UNAIDS Executive Director Michel Sidibé stated, "Women need safe contraceptive and HIV prevention options that they can own and manage. New investments into research for female controlled HIV prevention options and safe contraceptive methods are essential."

This statement was released alongside the unfortunate announcement that the Obama administration will reduce global AIDS funding by $214 million in fiscal year 2013.

It's time our national health experts and political leaders recognize that ending the HIV epidemic will take more than the rhetoric of an "AIDS Free Generation." It will take well-executed research, adequate resources, and an unwavering commitment to a world of health and opportunity for all.

Photo credit: Jon Rawlinson

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