Family Planning Choices for Women With HIV

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

Providers can use this list to ensure that they give women or couples with HIV accurate information, according to their needs and situation.

PREVENTING PREGNANCY

• Condoms are the only method that helps to protect against both pregnancy and STIs. With both male and female condoms, consistent and correct use is crucial to assure the best protection.
• Using condoms and another contraceptive method at the same time provides even more protection from pregnancy than condoms alone.
• Even if it is not possible to use condoms, a woman can use another contraceptive method to protect herself from pregnancy.
• A woman with HIV, including AIDS, and women on antiretroviral (ARV) medications can use almost any family planning method, including the intrauterine device (IUD) in many circumstances. It is recommended that she avoid spermicides, however.

BECOMING PREGNANT
Reduced fertility

• Women with HIV may have some difficulty becoming pregnant and maintaining a pregnancy.
• Men with HIV also may be less fertile.
• Neither HIV infection nor ARVs cause complete infertility. People with HIV still need to use a contraceptive method correctly if they want to prevent pregnancy.

Risks to baby

• There is much greater chance that babies of women with HIV will be miscarried, born prematurely, or be low weight at birth.
• If the woman has HIV, she can pass HIV to her infant during pregnancy, childbirth, or breastfeeding. Without special care, as few as 3 or as many as 10 in every 20 babies would be infected.
• If a woman with HIV also has malaria or another sexually transmitted infection (STI) such as herpes simplex virus, gonorrhea, and syphilis, she is more likely to pass HIV to her infant during pregnancy and delivery.
• ARVs given to the mother and/or infant greatly lower the risk of infecting the infant. The risk also can be lowered by cesarean-section delivery and by avoiding breastfeeding altogether or else practicing exclusive breastfeeding (giving only breastmilk), as opposed to mixed-feeding.

Risks to mother

• Pregnancy does not speed up the course of HIV infection, but it is best to avoid pregnancy when the health of the mother is poor.
• HIV infection raises the risk of childbirth complications such as postpartum fever and anemia, particularly if delivery is by cesarean-section.
• Opportunistic infections such as pneumonia, malaria, and tuberculosis can increase the risk of poor pregnancy outcomes such as preterm delivery and neonatal death.

Risks to partner

• If the woman is uninfected and her partner is infected, she may have to risk acquiring HIV while attempting to become pregnant. To lower the risk, advise having sex without condoms only on days that the woman is fertile.
• If the woman is infected and the man is not, artificial insemination would avoid the risk of transmitting HIV to him.
• If the partner has not been tested and will not get tested for HIV, it is safest to assume that he or she does not have HIV and to take precautions that minimize the risk of HIV transmission.

Care and treatment before and during pregnancy

• ARV regimens may need to be changed before trying to become pregnant—in particular, efavirenz may cause birth defects if taken during pregnancy.
• If there is any risk that she might get an STI, a woman should avoid sex or use condoms during pregnancy. STIs pose dangers to the baby and to the woman with HIV.
• Family planning after the child is born can be discussed and decided during pregnancy, and discussion of family planning choices can continue after the baby is born.
• Seek antenatal care and prevention of mother-to-child transmission of HIV services before and during pregnancy, if available.

Feeding the baby

• A woman with HIV should breastfeed exclusively (no other food or liquid) for the first six months and wean the child over a period ranging from two days to three weeks if appropriate replacement feeding is available.
• If—and only if—replacement feeding is acceptable, feasible, affordable, sustainable, and safe, mothers should not breastfeed.