Family Planning Choices for Women With HIV

Method

Considerations for Women With HIV

Male and female condoms

• The only method that helps protect against both pregnancy and STIs, including HIV.
• Must be used correctly every time to be fully effective.
• Maintaining consistent and correct use can be difficult.

Combined oral contraceptives (COCs)

• Not known if certain ARVs decrease effectiveness of COCs. In case they do, condoms provide extra contraceptive protection.
• Taking pills every day, without missing pills, is particularly important to compensate for any possible decrease in effectiveness when on ARVs.

Progestin-only pills (POPs)

• Not known if certain ARVs decrease effectiveness of POPs. In case they do, condoms provide extra contraceptive protection.
• Particularly appropriate for breastfeeding women who want pills. Exclusive breastfeeding, which is the safer breastfeeding option to reduce risk of HIV transmission to the infant, provides additional protection against pregnancy.
• For women who are not breastfeeding, taking pills every day, without missing a pill or pills, is particularly important in order to compensate for any possible decrease in effectiveness when on ARVs.

Progestin-only and combined injectable contraceptives

• Not likely that ARVs reduce effectiveness of injectable contraceptives. Still, women using ARVs should be especially careful to return on time for injections.
• Condoms could be used for additional protection from pregnancy, especially as the time of the next injection approaches or if a woman is late for her next injection.
• It is not necessary to have the next injection early or to shorten the injection interval.

Implants

• Not known if certain ARVs decrease effectiveness of implants. In case they do, condoms provide extra contraceptive protection.

Emergency contraceptive pills (ECPs)

• It is thought that ARVs do not reduce the effectiveness of ECPs.
• No evidence for increasing the ECP dosage for women on ARVs.

Copper-bearing intrauterine device (IUD) and levonorgestrel intrauterine device

• A woman who is at risk of HIV infection or who is infected with HIV can generally have an IUD inserted.
• A woman who has AIDS, is taking ARVs, and is clinically well can generally have an IUD inserted.
• A woman should usually not have an IUD inserted if she has AIDS and is not taking ARVs, or if she is taking ARVs, but is not clinically well.
• If a woman develops HIV or AIDS while she has an IUD in place, it generally does not need to be removed.
• A woman who has gonorrhea or chlamydia should not have an IUD inserted.
• IUD users with AIDS should be monitored for pelvic inflammatory disease.

Female sterilization and vasectomy

• Delay sterilization and vasectomy if currently ill with AIDS-related illness.
• Special arrangements are needed to perform female sterilization on a woman with AIDS and a vasectomy on a man with AIDS. The procedure should be undertaken only in settings with experienced staff and sufficient equipment and support.
• Female sterilization and vasectomy do not prevent transmission of HIV.

Lactational amenorrhea method (LAM)

• Women who are infected with HIV or who have AIDS and choose to breastfeed their infant can use LAM.
• Exclusive breastfeeding (without introducing any other foods, liquids, or water) for the first six months of a baby’s life is the safer breastfeeding pattern to minimize the risk of HIV transmission through breastmilk. This pattern of breastfeeding is compatible with LAM.
• If a woman’s monthly bleeding returns before six months, she will need another contraceptive method while continuing to breastfeed exclusively.
• Women with HIV and their health care providers need to consider the infant feeding options available and to weigh their various risks and consequences.

Fertility awareness methods

• Calendar-based fertility awareness methods rely on regular menstrual cycles. For women with advanced HIV (low CD4+ cell count), irregular cycles may be common and make these methods difficult to use.
• For most people, fertility awareness methods are less effective than are other modern methods of contraception.

Spermicides

• Women at high risk of HIV infection and who have very frequent intercourse should not use spermicides.
• Women with HIV infection, including AIDS, should not use spermicides.

Diaphragm

• Diaphragms may help keep infectious organisms from reaching the cervix, however a recent study found that diaphragms do not protect against HIV infection (261).
• Because diaphragms are used with spermicide, they are not generally recommended for women at high risk for HIV infection or women who are infected with HIV.