Recorded presentation

Tara Nutley, MPH, Field, Information and Training Services, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, (919) 544-7040, tnutley@fhi.org

This year several studies will produce data on the effect of hormonal contraception on HIV acquisition, transmission, and disease progression. Currently, the data on acquisition and transmission are inconclusive, but the data on disease progression suggest the possibility of a negative effect. Especially in countries in East and Southern Africa with high rates of depo provera use and HIV prevalence, the potential for emerging study results to negatively impact family planning (FP) programs is significant. In the mean time, the inconclusive but suggestive data pose challenges to providers of contraceptive services for HIV+ and at-risk women. While waiting for more evidence-based information, both FP and HIV programs may need to reconfigure their services to better meet the reproductive health needs of clients and prevent negative fall-out for FP use should new data support an association between hormonal methods and HIV risk. Considerations for FP programs, which have traditionally emphasized hormonal methods, include placing increased emphasis on condom use, resurrecting underutilized but safe and effective non-hormonal methods such as the IUD and sterilization, introducing the diaphragm, strengthening counseling so that clients can make informed choices about contraception, and integrating voluntary counseling and testing. At this point, non-hormonal methods should not be promoted to replace hormonals, but to ensure balanced contraceptive counseling that enables informed choice. HIV programs may want to consider an expanded focus on the dual risks of HIV infection and unwanted pregnancy, integrating balanced contraceptive counseling, and providing FP services on-site or strengthening referrals to FP programs.

Learning Objectives:

• 1. Discuss the existing data on the association between hormonal contraceptive use and risk of HIV acquisition, transmission, and disease progression.
• 2. Describe two challenges these data, and the gaps in these data, pose to contraceptive service delivery.
• 3. Articulate two contraceptive service delivery best practices given the current scientific evidence.

Keywords: International Family Planning, HIV/AIDS

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation