I know that women are at increased risk for HIV infection in Nigeria. I also know that there are lots of efforts to prevent unwanted pregnancy irrespective of HIV status. Birth control is critical to population control and national development. Unintended pregnancy is also a common threat to the well-being and lives of women and girls. Many governments in developing countries, including Nigeria, are embracing birth control programmes including those that increase access of girls and women to short and long term contraception. Many of these same countries that have high fertility rates like Nigeria, are also battling with large populations of persons living with HIV. But then, what is this thing about HIV and contraception use.
In 2017, the World Health Organization issued a public statement about of progestogen-only injectables such as Depo Provera (s for protection from getting pregnant for the next three months) and norethisterone enanthate [NET-EN] following a meeting convened in December 2016 to look at the evidence on the possibility of increasing HIV risk following the use of hormonal contraception. WHO recognized this as a critical one, particularly for sub-Saharan Africa, where women have a high lifetime risk of acquiring HIV, and hormonal contraceptives constitute a significant component of the contraceptive method mix.
The statement identified that there is a risk for HIV acquisition through the use of progestogen-only injectables (norethisterone enanthate [NET-EN] and depot medroxyprogesterone acetate [DMPA, intramuscular or subcutaneous]) for women at high risk of acquiring HIV. However, the advantages of using these methods to prevent unwanted pregnancies generally outweigh the possible increased risk of HIV acquisition.
There is currently no clinical trial derived evidence to show that any contraception, including progestogen-only injectables, increase the risk of acquiring HIV infections. However, multiple low to moderate evidence generated through secondary analysis of data collected for other research purposes but analysed to test possible associations between risk of HIV infection and use of contraception suggest that this association is plausible. The ongoing ECHOO study being implemented in South Africa will provide some evidence by 2019 on whether DMPA use increases a woman’s HIV risk or not.
Women needs to be educated about the choices they make about use of contraception. The following hormonal contraceptive methods can be used without restriction: combined oral contraceptive pills (COCs), combined injectable contraceptives (CICs), combined contraceptive patches and rings, progestogen-only pills (POPs), and levonorgestrel (LNG) and etonogestrel (ETG) implants as they are safe for use by anyone. Intrauterine devices (IUDs; levonorgestrel [LNG] and copper) are not associated with an increased risk for HIV acquisition also.
For women living with HIV, it is important to discuss contraceptive options also. Most anti-retroviral treatments do not interact with family planning drugs. Some family planning implants contain a hormone called etonogestrol that interacts with an ART called efavirenz. If you are living with HIV, it is wise to talk with your doctor or clinic about your family planning method. You can ask if there is any risk of your method interacting with your ART.
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