Family Planning Choices for Women With HIV

 

Population Reports: Making an Impact

EngenderHealth's USAID-funded ACQUIRE Project used this report to develop a rapid-response training program on integrating family planning into HIV services in Eastern Uganda (read more)

CONTENTS

Home (Key Points)

Supporting the Reproductive Decisions of Women With HIV

Box: Family Planning Is a Key Strategy to Reduce Mother-to-Child Transmission of HIV

Box: When a Woman With HIV Decides About Pregnancy

Box: Helping Women Talk With Their Partners About Contraception and Safer Sex

Box: Information Communication Technology: Mobile Phones Keep Women With HIV in Contact With Care

Women With HIV Can Safely Use Most Contraceptive Methods

Box: Dual Protection Strategies Help Prevent Pregnancy and STIs

Women With HIV Need the Facts About Pregnancy

Box: What People With HIV Need to Know About Pregnancy and
Preventing Pregnancy

Bibliography

Credits

• INFO Report: “Women and HIV: Questions Answered”
• Web Tool: Assess Your Attitudes and Beliefs About People With HIV
• Box: What People With HIV Need to Know About Preventing Pregnancy

• Table 1: Comparing Contraceptive Methods for People with HIV
• Table 2: Drug Interactions: Combined Oral Contraceptives and Antiretroviral (ARV) Medications
• Web Box: Condoms at a Glance

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In the Korogocho slums of Nairobi, Kenya, a mother with HIV (on right) discusses family planning with an HIV activist and trainer. In the mother’s lap rests one of her two children born after she was infected. Both children were born with HIV, but are receiving treatment and are healthy. Although her husband was exposed to HIV while trying for pregnancy, the couple carefully uses condoms now and her husband remains HIV-negative. She now trains others in her community on family planning and home-based care. (© 2007 Felix Masi/Voiceless Children, Courtesy of Photoshare)

KEY POINTS

Women with HIV have much the same reasons to have children or to prevent pregnancy as everyone else, but they have important additional issues to consider. These women’s health care providers have the responsibility to help them make well-informed and well-considered choices and carry out their decisions with the least risk.

Women with HIV can use nearly any family planning method.

• Correct and consistent use of male or female condoms can help avoid pregnancy and sexually transmitted infections (STIs). Other STIs can speed up progression of HIV disease.
• Especially if a woman with HIV cannot be certain of consistent condom use, an additional family planning method will offer further protection from pregnancy.
• All hormonal methods appear to be safe for women with HIV. Theoretically, certain antiretroviral (ARV) medications could reduce the effectiveness of low-dose hormonal methods, but condom use would make up for that.
• Most women with HIV can have an IUD inserted, including women with AIDS if they are using ARVs and are clinically well. A woman who has AIDS and is not using ARVs should not have an IUD inserted, nor should a woman with AIDS who is being treated but is not clinically well. An IUD already in place does not need to be removed if a woman becomes infected with HIV or other STIs, or she develops AIDS.

Couples with HIV who are thinking about having children need facts on the actual risks and how to reduce the chances of HIV transmission.

• Without treatment, 15% to 30% of infants of women with HIV are born infected. Another 10% to 20% are infected during breastfeeding.
• ARV prophylaxis and appropriate feeding practices can significantly lower the chances.
• Pregnancy does not have a major effect on progression of HIV disease.
• Women with HIV have a greater risk of adverse pregnancy outcomes such as preterm delivery or miscarriage.

How To Use This Report

With the help of this issue of Population Reports, family planning and HIV-care providers can:

• Understand how HIV affects women’s reproductive health and childbearing decisions (see Supporting the Reproductive Decisions of Women With HIV).
• Learn the latest, evidence-based information to help women with HIV think through their family planning choices (see Women With HIV Can Safely Use Most Contraceptive Methods).
• Inform women with HIV who are thinking about having children of the risks of transmitting HIV to the infant and/or uninfected partner and how they can reduce these risks (see Women With HIV Need the Facts About Pregnancy).

While Population Reports frequently addresses service delivery aspects of the topics it covers, this issue does not address service delivery for women with HIV. For information on integrating reproductive health and HIV service delivery, please visit the Web site “Resources for HIV/AIDS and Sexual and Reproductive Health Integration” at http://www.hivandsrh.org/