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

Preventing unintended pregnancies among women with HIV will substantially reduce the number of infants with HIV infection. Thus it is a major element in the world strategy to prevent mother-to-child transmission of HIV.

Already, prevention of unwanted pregnancies avoids many births of HIV-infected infants. A study using mathematical modeling estimated that, if there had been no contraceptive use in the world in 2006, an additional 2,940 infants infected with HIV would have been born each day, thus tripling the number of infants with HIV (178) (see Figure 2). In sub-Saharan Africa, with relatively low levels of contraceptive use, in 2006 there would have been about one-third more HIV-positive births if there had been no contraception at all.

In sub-Saharan Africa, where rates of HIV prevalence among women are the world’s highest, meeting the family planning needs of women with HIV has great potential to reduce further the number of HIV-positive births. It is estimated that one-fourth of all births in sub-Saharan Africa are unintended. Assuming that 25% of HIV-positive births are also unintended, meeting the family planning needs of all women with HIV in sub-Saharan Africa has the potential to avert 120,000 HIV-positive births each year (178).

Preventing unintended pregnancies in women with HIV also will reduce the number of abortions and the number of children orphaned by AIDS. Since the great majority of women with HIV do not know that they are infected (101), providing adequate family planning services for everyone would contribute greatly to preventing HIV-positive births—perhaps even more than would focusing just on the family planning needs of women who know that they have HIV.

Furthermore, preventing unintended pregnancies is a cost-effective strategy to prevent new HIV infections. Models show that for the same expenditure, increasing contraceptive use averts more HIV-positive births than a traditional preventing mother-to-child transmission (PMTCT) strategy of ARV prophylaxis (for disease prevention) (206, 211). For example, a study in eight African countries estimated that the same number of infections averted by providing nevirapine to all women with HIV giving birth could be averted at less cost by moderate reductions in the number of unintended pregnancies, ranging from 6% in Kenya to 35% in Rwanda (211). Both these strategies are important.

Preventing unwanted pregnancy is a key element in the four-element strategy for preventing mother-to-child transmission of HIV. As identified by the UN in the Glion Call to Action on Family Planning and HIV/AIDS in Women and Children (223), the four elements respond to health care providers’ four opportunities to reduce motherto- child transmission (246). The Glion Call to Action states that all four elements are essential for meeting the UN goal of halving the proportion of infants infected with HIV by 2010:

1. Primary prevention of HIV infection. Preventing HIV infection in women, including those who are pregnant or breastfeeding, is the most efficient way to avoid HIV infections in infants—and it saves women’s lives as well. Programs and policy makers can give attention to strengthening primary prevention services, such as counseling and testing, and condom provision. Providers can counsel couples on reducing their risk of acquiring HIV and other STIs, and offer condoms as needed.
2. Preventing unintended pregnancies in women with HIV. Family planning provides couples with HIV an opportunity to prevent unintended pregnancies and to avoid having children who are infected with HIV. Strengthening family planning programs for all women, especially in high prevalence settings, will reach many infected women who still do not know their status and need family planning. Providers can help women who want to avoid pregnancy choose and use a family planning method effectively (see 'Women With HIV Can Safely Use Most Contraceptive Methods').
3. Preventing HIV transmission from women to their infants. The risk that a woman with HIV will transmit the virus to her infant can be reduced in a number of ways—prophylaxis with ARVs during pregnancy and around the time of giving birth, certain ongoing ARV treatments (if the woman needs ARVs for her own health), cesarean-section delivery, and either avoiding breastfeeding altogether or exclusive breastfeeding for six months (see 'Women With HIV Need the Facts About Pregnancy').
4. Providing care, treatment, and support for mothers with HIV and their children. Offering ongoing care and treatment and support for mothers with HIV and their infants helps to ensure the mother’s health and to protect the child’s health and development.

To date, many HIV programs have focused mainly on the third element—specifically, providing ARVs to women who are already pregnant in order to reduce the risk of transmission of HIV to the infant (245). Much less attention has focused on preventing unintended pregnancies among women with HIV (207). Often this narrow focus is due to separate funding streams, which continue to treat family planning as if it were unrelated to HIV care. There is now a move, however, towards giving equal attention to all four strategic elements to prevent mother-to-child transmission of HIV.