The World Health Organization (WHO) has revised its recommendations regarding the use of contraception among women at high risk for HIV, reflecting new research that has found that women’s HIV acquisition rates do not differ based on the form of reversible birth control they use.
WHO now states that women can use any form of reversible contraception, including progestogen-only injectables, implants and intrauterine devices (IUDs) without affecting their HIV risk.
Since these forms of birth control do not protect against HIV or other sexually transmitted infections (STIs), WHO stresses the importance of consistent condom use where there is a risk for such infections. Women may also consider taking pre-exposure prophylaxis (PrEP) to prevent HIV.
WHO emphasizes that women should have access to the full array of contraception options.
“Evidence shows that a woman’s risk of HIV should not restrict her contraceptive choice,” Peter Salama, MD, executive director of Universal Health Coverage/Life Course at WHO, said in a press 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.”
An independent guideline development group reviewed the evidence about the association between hormonal contraception and HIV risk that has been published since WHO conducted a previous review in 2016. The group also referred to a systematic review of all published evidence regarding copper-bearing IUDs and HIV risk.
Particularly important to the latest review process was the ECHO study, a randomized clinical trial that found no significant differences in the HIV acquisition rate among women using intramuscular depot medroxyprogesterone acetate (DMPA-IM, or Depo-Provera), copper IUDs or levonorgestrel implants. The evidence from this study was considered high quality, while earlier observational studies that looked at such associations and informed WHO’s previous recommendations were considered to have only low-quality to low-moderate-quality evidence.
ECHO was conducted in Eswatini, Kenya, South Africa and Zambia. It found concerningly high rates of acquisition of HIV and other STIs among women seeking contraception, in particular young women.
“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,” said Felicitas Zawaira, MD, director of family and reproductive health in WHO’s African region. “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.”
To read a press release about the WHO declaration, click here.