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Hormonal contraception and HIV Risk

February 16, 2012

The health of many women in the developing world is threatened by both unplanned pregnancy and the risk of infection with HIV.  Recently there has been renewed attention paid to the possibility that use of hormonal contraception, particularly the 3 month injectable contraceptive DMPA (depot medroxyprogesterone acetate, also known by the brand name Depo-Provera) may increase women's risk of becoming infected with HIV.

The evidence that DMPA use affects HIV risk is mixed: some studies suggest an increased risk, others do not find an increased risk.  The global health community is working hard to examine this issue and provide women with the information that they need to make informed decisions regarding their contraceptive choices.

Two weeks ago the World Health Organization (WHO) gathered experts in contraception and HIV to consider what to advise women at high risk of HIV infection about using DMPA.  The results were announced today: they concluded that women living with HIV or at high risk of HIV can safely continue to use hormonal contraception including DMPA but they emphasized the need to use condoms for dual protection. WHO recommends no restriction on the use of DMPA, but noted the importance of collecting better evidence on DMPA use and HIV risk than we currently have.

Given this information, what should we do?  There are two important priorities.

The first is to do everything we can now to ensure that women have access to high quality counseling and a choice of contraceptives, including DMPA but also other highly effective contraceptives like implants and IUDs.  Women at risk of HIV infection must also be counseled that consistent and correct use of condoms is required even if they are using another contraceptive method.

The second priority is to conduct new studies to better understand what, if any, affect DMPA use has on the risk of HIV infection.  We are working with our partners to identify studies that will answer this critically important question. 

One of the most important outcomes of the WHO meeting was the agreement that the family planning and HIV communities need to continue to collaborate closely on this issue.  Millions of women are at risk of unplanned pregnancy and HIV infection – we must work together to ensure women can make informed and safe family planning choices that protect them against pregnancy and HIV and other sexually transmitted infections (STIs).

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