Home  |  Search  |  Info Publications  |  Dr. Shelton's Pearls  |  Population Reports  |  Español/Francais

Shopping Basket

	Women and HIV: Questions Answered
August 2007 Issue No. 14	The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org

Basic Facts About HIV Family Planning and HIV Health of Mother and Infant Mother-to-Child Transmission of HIV Sources Subscribing and Ordering Information How to Use This Tool Credits

Family Planning and HIV

Can women with HIV safely use family planning?

Generally, yes. Women with HIV/AIDS, including those who are taking ARVs, can start and use almost all family planning methods safely and effectively.

How well do condoms protect against HIV infection?

When used consistently and correctly, male condoms prevent 80% to 95% of HIV infections that would have occurred without condoms. Evidence on female condoms is not as extensive as male condoms, and it is not clear whether they provide the same level of protection against HIV as male condoms (51, 88, 93).

How well do condoms prevent pregnancy?

The effectiveness of condoms depends on the user. Risk of pregnancy is greatest when condoms are not used with every act of sex. As commonly used, about 15 per 100 women whose partners use male condoms become pregnant over the first year of condom use. This means that 85 in every 100 women whose partners use male condoms will not become pregnant. When used correctly with every act of sex, about 2 per 100 women whose partners use male condoms become pregnant over the first year.

As the female condom is commonly used, about 21 per 100 women become pregnant over the first year. This means that 79 of every 100 women using female condoms will not become pregnant. When used correctly with every act of sex, about 5 per 100 women using female condoms become pregnant over the first year (85).

What is meant by consistent and correct use of condoms?

Consistent condom use means using a new condom for every act of intercourse. For STI protection, this includes using condoms for anal intercourse.

Correct use means:

• Putting on a condom before beginning intercourse,
• Leaving the condom on until after intercourse is finished,
• Not flipping the rolled-up condom over after it has touched the tip of the penis,
• Not taking actions that could make a condom break, such as making a hole in it by opening the package with a knife or sharp fingernails, and
• Not taking actions that would make a condom slip, such as putting lubricant on the penis before putting on the condom (66).

Does a woman with HIV who is taking antiretroviral (ARV) medications need to keep using condoms?

Women and men can still transmit HIV even if they are taking ARVs. If one partner in a couple is uninfected or if his or her status is not known, the couple should continue to use condoms (8, 33, 68, 70, 87).

Are female sterilization and vasectomy safe for couples with HIV?

Yes. Women and men with HIV/AIDS, including those who are taking ARVs, can safely undergo female sterilization or vasectomy. For those with AIDS, special arrangements are needed. The procedures should be undertaken in settings with experienced staff and the necessary equipment and support. The procedure may need to be delayed if the client is currently ill with AIDS-related illness. If one partner does not have HIV, the couple does not have a strong preference, and both female sterilization and vasectomy are available, it is usually better for the partner who does not have HIV to have the procedure (34, 97).

Are intrauterine devices (IUDs) safe for women with HIV?

In most cases, yes. Most women with HIV can have a copper-bearing IUD or a hormonal IUD inserted. A woman who has been diagnosed with AIDS can start and continue using an IUD, but only if she is on ARV treatment and clinically well. If a woman becomes infected with HIV or develops AIDS while using an IUD, her IUD does not need to be taken out (73, 97).

Will using hormonal family planning methods make HIV disease progress more quickly?

It is not certain. Some studies, but not others, suggest that some hormonal contraceptives could speed the progression of HIV disease. More studies are needed. At this point there has been no change in the guidance that women with HIV can safely use hormonal methods (3, 9, 28, 39, 48, 54, 63, 81).

Do women with HIV experience different side effects or more side effects from contraceptives than uninfected women?

No. Contraceptive side effects such as bleeding changes with hormonal methods or IUDs appear to be similar in women with HIV and in uninfected women (31, 41, 42, 82, 83, 91).

Are women more likely to transmit HIV if they use hormonal contraception?

This is not known. The most important advice for women with HIV and their uninfected partners is to continue using condoms, whether or not they also are using hormonal contraceptives. Used consistently and correctly, condoms greatly reduce the risk of passing HIV.

Do hormonal contraceptives reduce the effectiveness of antiretroviral (ARV) medications?

This is not known. There are not many studies of this, but it appears that hormonal contraceptives do not reduce the effectiveness of currently available ARVs (11, 46, 49).

Do ARVs reduce the effectiveness of hormonal contraceptives?

This is not known. Two small studies have reported that the ARVs nevirapine and ritonavir could lower blood levels of hormones from oral contraceptives (OCs). It is not clear, however, whether this change is enough to lower their effectiveness. Consistent condom use would help to make up for any decrease in the effectiveness of OCs and also would help to protect an uninfected sexual partner from HIV. Also, women who are using both OCs and ARVs should take extra care to start their next pack on time and avoid missing pills. There is less concern about hormonal methods that do not involve pills—for example, combined and progestin-only injectable contraceptives (49, 58, 64, 80, 97).

Do hormonal contraceptives or the IUD increase a woman’s chances of getting HIV?

No, not for most women. The largest and most carefully conducted studies among women who are not at high risk for HIV infection find that women who use hormonal methods or copper-bearing IUDs are no more likely to get HIV than women who do not use these methods (40, 53, 54, 57).

Is emergency contraception safe and effective for women with HIV, including women using ARVs?

Yes. Emergency contraceptive pills (ECPs) are safe for women with HIV. As for effectiveness, ECPs contain higher doses of hormones than daily oral contraceptives. Therefore, it is thought that ARVs would not reduce the effectiveness of ECPs. There is no evidence that finds it is necessary to increase the ECP dosage for women taking ARVs (98).