1. Contraceptive Options for Women and Couples with HIV Fertility Awareness- based Methods

2. Fertility Awareness-based Methods Identify fertile window of the menstrual cycle –includes several days before ovulation and one day after –ovulation occurs close to the middle of the cycle –timing of ovulation varies from woman to woman and from cycle to cycle Methods use different means to identify the window –observe fertility signs (symptothermal method, cervical mucus method, TwoDay Method) –monitor cycle days (calendar method, Standard Days Method) Abstinence or barrier methods should be used during the fertile time Pregnancy rates: –perfect use 1% to 9% – typical use 12% to 25% Source: CCP and WHO, 2007.

3. Standard Days Method (SDM) SDM users consider themselves fertile on days 8-19 –use condoms or avoid sex on fertile days SDM users can utilize CycleBeads –track the days of their cycle and identify their fertile days SDM is appropriate for women with most of their cycles between 26 and 32 days long

4. Characteristics of SDM Effectiveness is similar to barrier methods: –correct use, 95% effective –typical use, 88% effective Low cost; no resupply needed; requires partner cooperation; no STI protection For couples who desire children, SDM can be used to plan which days to have sex

5. FAB-Method Use by Women with HIV Women who are HIV-positive with or without AIDS and those on ARV therapy: Can use without restrictions (SDM and calendar method rely on regular menstrual cycles) Should be encouraged to use condoms Source: WHO, 2004; updated 2008. If the client does not want more children, other methods that are less client-dependent should be considered.