What Works for Women and Girls

different; and progression to WHO clinic stage III or IV was also similar (Mwachari etal., 2008). (Gray III) (contraception, Kenya, Zimbabwe)Information on HIV status correlated with DMPA use among women ages 15 to 24years of age for 874 women in Kenya, 867 women in Lesotho, 931 women in Malawiand 1,877 women in Zimbabwe found that users of DMPA had consistently higher HIVseroprevalence, with differences from nonusers significant for Lesotho and Zimbabweand highly significant for the merged data set. However, “even if women shifted fromDMPA to the pill, the net effect on HIV prevalence would be small and unlikely tochange the course of the HIV epidemic” (Leclerc et al., 2008: 375). (Gray III) (DMPA,Kenya, Lesotho, Malawi)A study in the United States with 70 women, with 16 women who were not on HAART,who were followed for 12 weeks, found no significant changes in CD4 counts of HIVRNA levels occurred with DMPA use. No evidence of ovulation was detected and nopregnancies occurred. “Data suggest that DMPA can be used safely by HIV-positivewomen on the ARV studied [nucleoside; nelfinavir; efavirenz; nevirapine] (Watts et al.,2008: 85). (Gray III) (DMPA, contraception, HAART, treatment, United States)Based on results of five studies (Kapiga et al., 1998; Kiddugavu et al., 2003; Morrison et al.,2007; Myer et al., 2007b and Beaten et al., 2007 cited in Heikinheimo and Lahttenmaki etal., 2009), the use of oral contraceptives may be associated with an increased risk of HIVacquisition among sex workers; however, among other women, no increased risk of HIVwas observed during use of oral contraceptives (Leclerc et al., 2008 cited in Heikinheimoand Lahteenmaki et al., 2009). (Gray IV) (contraception, sex workers)“Among women from the general population, combined oral contraceptives and DMPAuse does not appear to significantly increase HIV acquisition risk; evidence from studiesconducted among high risk groups of women is more mixed… Additional research isurgently needed….” The assessment was based on a review of 13 prospective studies(Morrison, 2009). (Gray IV) (contraception, DMPA)A review of peer-reviewed literature for prospective studies published between 1996and August 2008 found that data suggest that neither oral contraceptives nor DMPAincrease HIV risk among women in the general population. Data are equivocal for sexworkers. Data suggested no increased risk among copper IUD users. Women’s contraceptivepreferences would make randomized controlled trials unethical. “Care shouldbe taken…to avoid inducing unwarranted concern about risks associated with contraceptiveuse” (Morrison et al., 2009: 280). (Gray V) (contraception, sex workers)Use of injectable contraception may increase risk of HIV acquisition for sex workersbut not for other women (Ungchusak et al., 1996; Baeten et al., 2007; Kapinga et al.,1998; Kiddugavu et al., 2003; Morrison et al., 2007; Beaten et al., 2007; Kleinschimdtet al., 2007 cited in Heikinheimo and Lahteenmaki, 2008). (Gray V) (contraception, sexworkers)194 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV