What Works for Women and Girls

Integrating HIV and Contraceptive Services Can Meetthe SRH Needs of WomenAs women are living longer, healthier lives with HIV due to expanded access to treatment,there is an increased need for access to contraceptive methods suitable for women on antiretroviraltherapy. “In studies of women with HIV infection approximately 70% are sexuallyactive, effective contraceptive use is variable and unplanned pregnancy is frequently reported”(Desgrées-Du-Loû et al., 2002; Magalhaes et al., 2002 cited in Mitchell and Stephens, 2004:167). A recent study in seven African countries found that within four years of initiating antiretroviraltherapy, one-third of the women who initiated ARV therapy experienced a pregnancy.The treatment program did not include any contraceptive counseling or provision of contraceptives.“…[T]he design and operation of most HIV treatment services do not explicitly acknowledgethe likelihood or the actual occurrence of pregnancy” (Myer et al., 2010). IntegratingSRH, including provision of contraception, with other HIV services can increase contraceptiveuse and reduce unintended pregnancies (Duerr et al., 2005). Antiretroviral programs haveregular contact with women living with HIV over long periods of time and as a result are aparticularly important venue for meeting the reproductive health needs of women living withHIV (Myer et al., 2007a). Most clients would rather access contraceptive services at the samesites they receive HIV services (Asiimwe et al., 2005; Farrell and Rajani, 2007).Many positive women do not receive appropriate information from providers about contraceptiveoptions, including dual protection, and lack access to contraceptives and emergencycontraception (WHO, 2004). This applies equally to positive women who wish to avoid pregnancyand to those who discover their HIV status during pregnancy. Providers and clientsneed to know that research on hormonal contraceptives has not resulted in any changes tofamily planning guidelines for women living with HIV (FHI, 2008). A 2009 systematic reviewof hormonal and intrauterine contraception for women living with HIV found that althoughone randomized trial raised concerns about enhanced disease progression, the evidence was“generally reassuring regarding adverse health effects, disease transmission to uninfectedpartners, and disease progression” (Curtis et al., 2009). Clients should also know that whileno method of contraception other than male and female condoms has been proven to protectagainst STIs including HIV, condoms are not the most effective method to prevent pregnancy(WHO/RHR and CCP, 2007), so dual protection is warranted. More countries need guidelinesand training regarding antiretroviral treatment and contraceptive options for women of reproductiveage (Stevens, 2007) and guidelines on HAART regimens for women of reproductiveage are being developed (Stevens, 2009).ARV treatment programs should be part of a continuum of care that includes contraceptiveand other integral health services from the onset (Shelton and Peterson, 2004; Farrell, 2007).Inclusion of contraceptive care in ARV treatment will take effort; in some cases, women livingwith HIV are denied information about safer sex because it is believed that they should notbe having sex (Esplen, 2007). In fact, “sexual and reproductive health services need to provideWHAT WORKS FOR WOMEN AND GIRLS185