The INFO Project Blog

Antiretrovirals (ARVs) given as prophylaxis reduce mother-to-child transmission (MTCT) of HIV by decreasing replication of HIV–and thus the amount of virus–in pregnant women and by protecting newborns during and after exposure to HIV. The simplest regimen, and the most practical and cost-effective regimen in resource-low settings, is a single dose of neviripine (NVP) given to the mother at the onset of labor plus a single dose for the infant soon after birth. This intervention can reduce MTCT by one-third.

The recent issue of Population Reports, “Family Planning Choices for Women With HIV” highlights what providers and women with HIV need to know about preventing mother-to-child transmission.

To date, studies have not found that ARVs given as prophylaxis during pregnancy for MTCT place mothers and infants at greater risk for serious or life-threatening events. There is a concern, however, that women who have received NVP during pregnancy will develop NVP-resistant mutations of HIV, which, if spread, would make it difficult to successfully treat infected mothers and their babies with NVP in the future.

The topic came to our attention today with news from AFP about reduced drug resistance in a new drug therapy.

The article discusses results of a recent clinical trial published in the latest issue of the Lancet. Researchers found that adding a single dose of tenofovir and emtriciabine (two other NNRTI ARVs) at delivery reduced maternal resistance to NNRTIs by 50%. The study notes that this finding is “especially relevant now that both drugs have been incorporated into first-line treatment in many African countries.”

These results are good news for mothers with HIV and for programs in resource-scarce settings. Adding the new single-dose combination to to the standard single-dose NVP treatments is a low-cost, feasible approach to protect the health of mothers with HIV and the health of their future children.

Click here for more resources on preventing mother-to-child transmission of HIV.

Posted by Katie Richey, INFO Project

Our South African colleague raises some key issues. Sexual violence and male involvement are important aspects of any FP/HIV initiative. All women with HIV, including those who encounter sexual violence, need access to health care providers who are knowledgeable about family planning and reproductive health in the context of HIV.

Providers can help women with HIV make informed reproductive health decisions and plan how to talk with their partners about contraception and safer sex. The World Health Organization counseling tool, “Reproductive Choices and Family Planning for People Living with HIV” offers guidance for providers to help women make informed choices and includes tips on talking with partners.

Does anyone have additional input on provider’s perceptions of counseling and providing care to women with HIV? In your experience, are providers aware that women with HIV can use nearly any family planning method? Do women with HIV encounter unnecessary medical barriers to family planning?

Catherine E. Richey, MPH
Senior Technical Writer
The INFO Project
Johns Hopkins Bloomberg School of Public Health

A colleague from South Africa wrote…

“While this is an excellent and welcome contribution, I am concerned about gaps already.

I think we need to lay out issues carefully, if we are to really make headway. For many women there is a need to deal with not being in safe situations to negotiate safe sex. It seems like this kind of orientation is not acknowledged. The language that is used assumes that married heterosexual couples are the dominant kind of relationship.

While there is work happening on ‘working with men’ there needs to be equal efforts to engage women to understand patterns of sexual violence. How do women negotiate safer sex with a drunken husband upon whom she is economically dependant?
We need to acknowledge and make headway on female controlled methods of femidoms and micorbicides. We need to popularise emergency contraception and also deal with the reality of unwanted pregnancy and abortion.”

Press Release

For Immediate Release
September 20, 2007

Send this announcement to a colleague

Hopkins Report: Focusing on Family Planning Lessens HIV Impact

Baltimore, MD—Current family planning use prevents over one million HIV-positive births worldwide each year and has great potential to further reduce the number of infants born with HIV, according to the latest issue of Population Reports, “Family Planning Choices for Women With HIV,” published by the INFO Project at Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs.

Women account for nearly half of the estimated 40 million people living with HIV worldwide. The majority of these women are in sub-Saharan Africa, where there are three infected women for every two infected men. An estimated one-fourth of pregnancies in sub-Saharan Africa are unintended.

In sub-Saharan Africa, family planning currently prevents an estimated 190,000 unintended HIV-infected births each year, or more than 515 HIV-infected births per day. An additional 120,000 HIV-positive births could be averted per year if all unintended pregnancies among women with HIV were prevented. These new estimates of family planning’s contribution to reducing HIV were prepared by Family Health International for this issue of Population Reports.

Preventing unintended pregnancies in women with HIV is one of the most cost-effective strategies to prevent new HIV infections, according to the report. In some African countries money spent on avoiding unintended pregnancies would prevent more HIV-positive births than spending the same amount on antiretroviral (ARV) prophylaxis for HIV-positive women giving birth. By extension, preventing unintended pregnancies also will reduce the number of abortions and the number of children orphaned by AIDS.

To prevent pregnancy, women with HIV can safely use most contraceptive methods, with just a few exceptions. Even women using ARV therapy can choose any method available. Fears about the IUD have proved too broad. According to the latest guidance from the World Health Organization, any woman with HIV can use an IUD unless she actually has AIDS and is not well.

For women with HIV who are thinking about a baby, the new Hopkins report puts the risk in perspective. “Couples with HIV who are thinking about having children need facts on the actual risks and how to reduce the chances of HIV transmission,” write authors Catherine Richey and Vidya Setty.

Without treatment, 15% to 30% of infants of women with HIV are born infected. Another 10% to 20% are infected during breastfeeding. ARV prophylaxis and appropriate feeding practices can significantly lower these chances.

“The facts in this report should reassure both HIV-care practitioners and family planning practitioners that providing family planning to women with HIV is not difficult and not dangerous,” says author Catherine Richey. Co-author Vidya Setty adds, “It also should reassure practitioners that, if a woman with HIV chooses pregnancy, the risks of mother-to-child HIV transmission can be reduced if care is available, although they cannot be avoided entirely.”

Family planning and HIV-care providers can use the 24-page Population Reports issue and its companion 8-page INFO Reports issue, “Women and HIV: Questions Answered,” to:

• Understand how HIV affects women’s reproductive health,
• Learn the latest evidence behind global guidance on family planning methods for women with HIV, and
• Help women with HIV think through the risks of childbearing and learn how to reduce these risks.

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Find These Reports and Related Resources Online:

The full-text version of this Population Reports issue is available at http://www.infoforhealth.org/pr/l15/l15.pdf

The full-text version of the INFO Reports companion issue is available at http://www.infoforhealth.org/inforeports/women_hiv/womenhiv.pdf

Highlights of these and other INFO Project publications are also available as PowerPoint Presentations, which you can download and use to prepare talks and presentations, at http://www.infoforhealth.org/pr/powerpoints.shtml

Join the authors in a blog discussion September 24 through October 5, 2007: http://www.infoforhealth.org/blog/

To order this latest Population Reports issue and its companion INFO Reports issue in print, go to http://www.jhuccp.org/cgi-bin/orders/orderform.cgi. For a listing of all Population Reports issues online, go to http://www.populationreports.org. Population Reports is published three times a year in English, French, and Spanish by the INFO Project at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs. The INFO Project receives support from the US Agency for International Development.

For more information, contact Jeffrey Bernson, jbernson@jhuccp.org

Disclaimer: The information provided in this press release is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development, the U.S. Government or the Johns Hopkins University.

We would like to change gears from continuing client services to issues pertaining to family planning choices for women and couples with HIV. This change in topic is due to the fact that we will be publishing a Population Reports issue, Family Planning Choices for Women With HIV, in the upcoming months. One of the authors, Catherine Richey, has contributed these questions for discussion.

+ What are the considerations that a woman or couple with HIV faces when deciding to prevent or pursue pregnancy?

+ What are a health care provider’s responsibilities when counseling a client with HIV who is thinking about having a baby?