What Works for Women and Girls

An open label pharmacokinetic study of drug interactions among 54 HIV-positive womentreated with DMPA in the USA while on different antiretroviral therapies—nelfinavir,efavirenz or nevirapine—found that suppression of ovulation was maintained, contraceptionwas effective and there were no significant changes in median CD4 cell countat week 12 compared to baseline. DMPA, also known as Depo-Provera, is one the morefrequently used contraceptive methods globally and is often used by women living withHIV (Cohn et al., 2007). (Gray V) (DMPA, contraception, USA)“Biological and epidemiological studies suggest that hormonal contraceptive use couldinfluence susceptibility to HIV-1, as well as infectivity and disease progression for thosewho become infected. However, not all studies have shown this relationship and manyquestions remain” (Baeten et al., 2007: 360). (Gray V) (contraception)3. Women with HIV can use IUDs if they have access to medical services in case of IUDexpulsion.A randomized trial of 599 HIV-positive women to receive either IUD or hormonalcontraception in Zambia (no year given) found that women who received hormonalcontraception were more likely to experience a CD4 count decline to less than 200cells/UL than were women who received the IUD. Over 642 woman-years of follow-up,one woman who received the IUD experienced Pelvic Inflammatory Disease (PID). Tenwomen expelled their IUDs; of these four were partial expulsions that required medicalattention and six were complete expulsions. Only one woman who had experiencedexpulsion elected to have the IUD reinserted. Overall 184 patients (31%) discontinuedtheir originally allocated form of contraception over a 24-month follow-up. Womenassigned to hormonal contraception were more likely to become pregnant than werewomen who were assigned to the IUD (4.09 pregnancies per 100 women years vs..38 pregnancies per 100 woman years). No cases of PID occurred among participantswho received hormonal contraception. Women who received hormonal contraceptionwere less likely to discontinue than were women who received the IUD (Stringer et al.,2007). (Gray II) (contraception, Zambia)A review performed by an independent expert group using 1,000 references related toIUDs found that: there are no known drug interactions between IUDs and HAART;there appears to be no effect of IUDs on HIV-1 viral shedding; there appears to be noincrease in overall complications or infections with IUDs; and there is no increase riskof transmission to HIV-negative partners by HIV-positive IUD users (Castano, 2007cited in Martinez and Lopez-Arregui, 2009). (Gray III) (contraception, HAART)4. Providing information and skills-building support to HIV-positive people can reduceunprotected sex.A meta-analytic review based on electronic databases from 1988 to 2004, with twelvetrials in the USA that used randomization, statistical analysis and assessment ofWHAT WORKS FOR WOMEN AND GIRLS195