1. Contraceptive Options for Women and Couples with HIV Male and Female Sterilization Male Female

2. Surgical Sterilization Good for couples who want no more children Safe, simple surgical procedure Considered permanent Very effective; pregnancy rates: –female: 0.5% after one year, increasing to 1.85% over ten years –male: 0.1% to 0.15% (possibly higher) Female Source: CCP and WHO, 2007. Male

3. Sterilization – Mechanism of Action Female Prevents pregnancy by preventing sperm from reaching the egg Prevents pregnancy by preventing sperm from entering the semen; semen is ejaculated without sperm Male

4. Sterilization – Who Can Use Sterilization is appropriate for people who: Do not want any more children Want highly effective contraception Want permanent protection Have difficulty with temporary methods requiring compliance or resupply There are no medical restrictions for age or parity. Source: WHO, 2004; updated 2008.

5. No medical reasons to deny sterilization to clients with HIV Procedure may be delayed in event of acute HIV-related infection Encourage condom use to prevent STI/HIV transmission Sterilization Use by Clients with HIV Source: WHO, 2004; updated 2008.

6. Sterilization – Counseling Informed choice (avoid pressure) –provide appropriate information about contraceptive options –give preferred method if possible Carefully discuss decision to end fertility –sterilization is permanent; other long-acting methods available If doubts about sterilization, recommend delay

7. Sterilization – Counseling continued … Inform that complications are rare but may occur –infection, bleeding –adverse reaction to anesthesia Clarify – no systemic side effects Explain time-to-effectiveness –female sterilization: immediately –male sterilization: avoid unprotected sex for 12 weeks after procedure Discuss lack of STI/HIV protection Source: WHO, 2004; updated 2008.

8. Dispelling Myths about Sterilization Female: No loss of sexual desire Eggs do not build up in the body Menstruation occurs, but no longer signals fertility Tubes cannot simply be united for reversal Male: Vasectomy is not castration No effect on quantity of ejaculate No loss of male physical traits or strength Sperm does not build up in the body