Technical consultation on hormonal contraception and HIV
From January 31-February 2 (2012), WHO’s Reproductive Health and Research department held a technical consultation on hormonal contraception and HIV, in order to dicuss the mixed evidence about some kinds of hormonal contraception enhancing the probability of an HIV infection. Civil society was present among other experts in the SRH field.
After careful review of the available evidence, including some studies suggesting that women using progestogen-only injectable methods may be at higher risk of acquiring HIV, and others that did not show this association, the group concluded that the data were not sufficiently conclusive to change current guidance on the usage of hormonal contraceptives for women at risk of or living with HIV.
The group issued strong recommendations for giving women a range of contraceptive options, including dual protection methods that would prevent unwanted pregnancies and HIV, such as male and female condoms.
Especially relevant is the statement issued by women’s health advocates (below) that reflects grassroots concerns.
Collaborative Statement from Women’s Health Advocates WHO and Partners Stakeholders' Meeting on Hormonal Contraception and HIV
Geneva, January 31, 2012
As women’s health advocates and representatives of the women and HIV community, including women living with HIV, we seek your leadership to ensure that the upcoming WHO and Partners Stakeholders’ Meeting On Hormonal Contraception And HIV Recognizes the critical importance of expanding women’s sexual and reproductive health choices through ensuring access to essential family planning services; championing existing technologies such as the male and female condom; investing in new reproductive and women--‐centered HIV prevention technologies, including possible new barrier methods such as the cervical cap; and promoting the rights of women everywhere.
Whilst we acknowledge this observational evidence, it is crucial that women are not left without alternative acceptable methods for contraception should recommendations be made to withdraw Depo--‐Provera from communities. Women should not become more vulnerable in the name of advancing science. The recent questions about the relationship between hormonal contraception and HIV transmission should not be seen or treated as a zero--‐sum game in which women lose out in either instance, but instead as an opportunity to advance human rights, science and public health.
As global advocates, we recognize the diversity of perspectives at hand and fully endorse the recommendations made by last week’s African women's consultation in Kampala convened by ICW East Africa and AVAC. Building from these, we echo six key actions for moving forward in a time where millions of women’s lives are at stake:
- Meaningfully include and consult women in all our diversity, including young women and women living with HIV
- Scale up existing women--‐centered and controlled barrier methods such as the female condom which work for women living with HIV and at risk of HIV
- Promote information and full disclosure of possible associated risks to women, while providing real, practical and accessible alternatives to hormonal contraception
- Rather than invest resources in further randomized control trials, focus research resources “to activities that denote real progress in bringing new, paradigm--‐changing, multipurpose technologies to women” (Gollub, Stein 2012) such as invisible and long--‐lasting barrier methods and avoid the ethical pitfalls which more research on the possible HIV risk associated with hormonal contraception would present
- Work to expand women's sexual and reproductive choices to fill the massive unmet need for prevention of unplanned pregnancies, HIV, STI’s and perinatal HIV transmission
- Invest in women--‐friendly implementation as a primary concern for all the options
