Contraceptive Options for Women and Couples with HIV

Factors Affecting Method Choice Women and couples with HIV may consider: Safety and effectiveness of the method Duration of protection desired Possible side effects Ease of use Cost and access to resupply Effect on breastfeeding (if postpartum)

Factors Affecting Method Choice continued... How it may interact with other medications, including ARVs Whether it provides protection from STI/HIV transmission and acquisition Whether partner involvement or negotiation are required

Pregnancy Rates by Method Source: CCP and WHO, Oral contraceptives Percentage of women pregnant in first year of use Rate during typical use Rate during perfect use Female condom Female sterilization Implants DMPA Spermicides Standard Days Method Male condom IUD (TCu-380A)

Comparing Effectiveness of Contraceptive Methods More effective Less than 1 pregnancy per 100 women in 1 year Less effective About 30 pregnancies per 100 women in 1 year Injectables: Get repeat injections on time Lactational Amenorrhea Method (for 6 months): Breastfeed often, day and night Pills: Take a pill each day Patch, ring: Keep in place, change on time Condoms, diaphragm: Use correctly every time you have sex Fertility-awareness based methods: Abstain or use condoms on fertile days. Newest methods (Standard Days Method and TwoDay Method) may be easier to use. How to make your method more effective Implants, IUD, female sterilization: After procedure, little or nothing to do or remember Vasectomy: Use another method for first 3 months Withdrawal, spermicides: Use correctly every time you have sex *Spermicides and diaphragms with spermicide should not be used by women with HIV or at risk of HIV. InjectablesPills LAM Male Condoms Female Condoms Diaphragm* Spermicides* IUD Female Sterilization Vasectomy PatchVaginal Ring Fertility-Awareness Based Methods Withdrawal Implants Source: CCP and WHO, 2007.

Medical Eligibility for Contraceptives Evidence-based recommendations Periodic expert reviews 19 contraceptive methods Variety of medical conditions including HIV infection, presence of AIDS, and use of ARV therapy

Unacceptable health risk Risks generally outweigh benefits Benefits generally outweigh risks No restriction for use Description Method not to be used4 Use of method not usually recommended, unless other methods are not available/acceptable 3 Generally use the method 2 Use the method under any circumstances 1 When clinical judgment is available Category WHO Eligibility Criteria Source: WHO, 2004; updated 2008.

WHO Eligibility Criteria Source: WHO, 2004; updated Do not use the method 3 When clinical judgment is limited Category 2 Use the method 1

WHO Eligibility Criteria: Examples Source: WHO, 2004; updated Current breast cancer Breastfeeding a baby less than 6 weeks postpartum Anemia Uterine fibroids Medical Condition/ Characteristic Category Hormonal implants DMPA IUD COCs Contraceptive Method

Contraceptive Method Options Barrier methods Oral contraceptive pills Injectables Implants Intrauterine device (IUD) Female and male sterilization Lactational amenorrhea method (LAM) Fertility awareness-based methods Couples with HIV have a wide range of methods from which to choose.