What Works for Women and Girls

contraception: 57% used hormonal contraceptive methods and barrier contraceptivemethods. Among sexually active women, contraceptive use was 85%, a much highercontraceptive prevalence rate than in the general female population (23%). Clinic visitsfor those on HAART is monthly and for those HIV-positive patients not on HAART,every three months. Median HAART use was 15 months (Andia et al., 2009). (Gray IV)(HAART, contraception, Uganda)A 2007 study with 493 HIV-positive women in Uganda found that easy access tofamily planning services was significantly associated with contraceptive use amongHIV-positive women accessing HAART services (Ssewankambo et al., 2009). (Gray V)(family planning, HAART, Uganda)A review of family planning records from 2005 until 2007 of 600 HIV-negative womenand 150 HIV-positive women in Malawi found that providing on-site family planningservices to women participating in HIV-related research studies was well accepted withhigh uptake: At the initial visit 79% chose Depo-Provera; 17% chose contraceptive pills,3% chose Norplant and 1% used condom use only. In follow-up visits, 3% were referredfor sterilization and less than 5% changed their initial contraceptive method (Kachipapaet al., 2008). (Gray V) (family planning, contraception, Malawi)A study in 2005 of 227 women attending a hospital based antiretroviral program inSouth Africa found that one-third reported the combined use of a condom and a nonbarriercontraceptive at last sexual intercourse. Women initiating ART are also counseledon effective contraception, provided through referral to a nearby primary care clinic.Of 227 women, 86% discussed condom use with their providers and 89% discussedcontraceptive use However, less than 10% knew of the existence of emergency contraceptionand only 13% knew that abortion is a legal and free public health service (Myeret al., 2007a). (Gray V) (condom use, contraception, South Africa)2. Hormonal contraception is safe for HIV-positive women and does not seem to affect HIVacquisition or HIV progression.A systematic review of evidence from 26 studies on the safety of hormonal and intrauterinemethods of contraception for women with HIV/AIDS found that hormonal andintrauterine methods of contraception was generally well tolerated by women with HIV.Eight observational studies reported no increased risk of HIV disease progression withhormonal or intrauterine contraceptive use, whereas one randomized controlled trialfound increased risks of declining CD4 cell count and death for hormonal contraceptiveusers compared with intrauterine device users. Women with HIV who used hormonalcontraception had increased risk of acquiring STIs compared to women not usinghormonal contraception, similar to the risk reported among HIV-negative women. Onestudy found no association between hormonal or intrauterine contraceptive use andincreased risk of HIV transmission to uninfected partners, whereas findings from ninestudies examining contraceptive use and viral shedding from the genital tract (a proxy192 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV