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WHO: Contraceptive Advice Not Changed—Dual Protection Urged

Author: Mark Mascolini


19 February 2012

After reviewing all recent data on HIV transmission risk with hormonal contraceptives, the World Health Organization (WHO) maintained its advice not to restrict use of hormonal contraceptives to avoid unintended pregnancies. Women using progestogen-only injectable contraceptives, WHO says, should also use condoms or other measures to prevent HIV infection.

A Partners in Prevention study of 3790 heterosexual HIV-discordant couples (one partner positive and one negative) in Africa found that hormonal contraceptive use doubled the risk of HIV acquisition in women and doubled the risk of HIV transmission from positive women to negative men (Heffron R, et al, for the Partners in Prevention HSV/HIV Transmission Study Team. Lancet Infect Dis. 2012; 12: 19-26).

Oral or injectable hormonal contraceptives did not raise the risk of HIV acquisition in a separate study of 5500 South African women, though the investigators cautioned that “the effect estimate does not rule out a moderate increase in HIV risk associated with DMPA use found in some other recent studies” (Morrison CS, et al. AIDS. 2012; 26: 497-504).

“After careful review of all available evidence,” stakeholders at the WHO meeting “found that the data were not sufficiently conclusive to change current guidance,” a UNAIDS press release states.

WHO noted that “only condoms, male and female, provide dual protection by stopping HIV transmission and preventing unintended pregnancies.” The WHO panel stressed that “this information must be communicated to sexually active women and girls by health workers pro-actively.”

Among 1.18 billion 15-to-49-year-old women worldwide, WHO estimates that 11% have unmet family planning needs. Among 128 million married or partnered women that age in sub-Saharan Africa, 25% have unmet family planning needs.

Reflecting the recent evidence on HIV acquisition and transmission risk in women using hormonal contraceptives, WHO added this clarification to its recommendations:

“Some studies suggest that women using progestogen-only injectable contraception may be at increased risk of HIV acquisition, other studies do not show this association. A WHO expert group reviewed all the available evidence and agreed that the data were not sufficiently conclusive to change current guidance. However, because of the inconclusive nature of the body of evidence on possible increased risk of HIV acquisition, women using progestogen-only injectable contraception should be strongly advised to also always use condoms, male or female, and other HIV preventive measures. Expansion of contraceptive method mix and further research on the relationship between hormonal contraception and HIV infection is essential.”

The Partners in Prevention researchers (Heffron et al) believe “women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1.”

Sources:

UNAIDS. Press statement. Women need access to dual protection—effective contraceptives and HIV prevention options. 16 February 2012.

World Health Organization. Hormonal contraception and HIV: Technical statement. WHO/RHR/12.08. February 2012.

For the UNAIDS press statement

For the WHO technical statement