Contraception for Prevention of Unintended Pregnancies Among Women Living with HIV
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The World Health Organization (WHO) recommends the implementation of a comprehensive strategic approach for preventing HIV infection among infants and children that includes four elements [1]. This AIDSTAR-One resource page relates to Element Two. Most Preventing Mother-to_Child (PMTCT) efforts to date have focused on HIV testing to identify pregnant women who are HIV-infected and providing them with antiretroviral prophylaxis (Element Three). The role of contraceptive use in preventing infant HIV infections has received relatively less attention, but is no less important.
The overall health benefits for mothers and babies of avoiding unintended pregnancies are well understood. Prevention of mother-to-child transmission of HIV provides another compelling rationale for the widespread availability of contraception. Research has shown that nearly all contraceptive methods are safe and effective for women living with HIV, including those who are taking a variety of ARV drugs for prophylaxis or treatment. With women of childbearing age accounting for nearly half of all individuals infected with HIV globally, providing contraception to prevent unintended pregnancies in HIV-infected women can have a major impact on reducing HIV-positive births and infant and child deaths from AIDS-related causes. In fact, according to one estimate, contraceptive use in sub-Saharan Africa may already be averting 22 percent of HIV-positive births, despite the fact that contraception is not widely available in sub-Saharan Africa [2].
To more fully reap the benefits of contraception as an HIV prevention strategy, greater integration of family planning (FP) and HIV programs is needed, particularly in generalized epidemic settings where women of childbearing age are disproportionately affected by HIV and AIDS. While many ministries of health and implementing partners are now scaling-up integrated FP/HIV services, a number of obstacles continue to impede this process. These include separate funding for these two programs, the vertical organization of health ministries and service facilities, and the lack of evidence of effective integrated service delivery approaches.
- “Strategic approaches to the prevention of HIV infection in infants.” Report of a WHO meeting, Morges, Switzerland, March 20-22, 2002. Geneva, World Health Organization, (2003).
- Reynolds H. V., Steiner M. J., and Cates W. Jr.. “Contraception’s proved potential to fight HIV.” Sex Transm Infect (2005) Apr., 81(2)184-5.
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