PEPFAR and USAID. (September 2013). Washington, DC.
This brief, directed to national policymakers, U.S. Government (USG) program managers, and implementing partners, summarizes evidence and recommendations on hormonal contraception (HC) and HIV, and identifies implications for policies and programs. The report discusses HC use in terms of whether HIV-negative women will acquire HIV, women living with HIV will infect male sexual partners, women living with HIV will have quicker disease progression, and whether women being treated for HIV will experience drug interactions. HC use does not protect against HIV, and since evidence on increased risk with use of progestogen-only injectable contraception is inconclusive, women at risk who use HC should be advised to consistently use condoms and other preventive measures. Hormonal contraception does not protect against onward HIV transmission; thus, HIV-positive women should be advised to use condoms. If any HC method is found to increase HIV risk, it should be balanced against the life-saving benefits of effective methods to prevent unintended pregnancy. Policies should aim for the greatest public health benefit, which will vary according to the epidemiologic context. HIV testing and counseling should be available through family planning services, and the World Health Organization’s HC/HIV guidelines should be used to develop country guidelines. The USG supports research to develop multipurpose prevention technologies, and to improve understanding of potential associations between HC and HIV.