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MEDICAL NEWS
Year : 2020  |  Volume : 18  |  Issue : 1  |  Page : 64-65

Updates on contraception services for women at high risk of human immunodeficiency virus: World Health Organization


1 Vice - Principal Curriculum, Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpattu, Kancheepuram, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpattu, Kancheepuram, Tamil Nadu, India

Date of Submission05-Nov-2019
Date of Decision20-Nov-2019
Date of Acceptance30-Nov-2019
Date of Web Publication03-Feb-2020

Correspondence Address:
Dr. Saurabh Ram Bihari Lal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpattu - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_57_19

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  Abstract 


Use of contraception has been recommended to prevent pregnancy, practice family planning and also to prevent the acquisition of sexually transmitted infections. It is important to advocate that regardless of geographical settings, all the women should have access to the wide range of contraceptives, so that based on their preferences or values, an appropriate and well-informed choice can be made. The revised recommendation for women at high risk of HIV advocates for the use of any form of reversible contraception, including progestogen-only injectables. In conclusion, the sexual and reproductive health needs of all women are quite variable and it becomes even more challenging for the women who are either at high risk of HIV or HIV positive. The recent recommendations to expand the range of services offered, including contraceptive methods, is an important step, but will also require strengthening of the existing services.

Keywords: HIV, contraception, World Health Organization


How to cite this article:
Shrivastava SR, Shrivastava PS. Updates on contraception services for women at high risk of human immunodeficiency virus: World Health Organization. Curr Med Issues 2020;18:64-5

How to cite this URL:
Shrivastava SR, Shrivastava PS. Updates on contraception services for women at high risk of human immunodeficiency virus: World Health Organization. Curr Med Issues [serial online] 2020 [cited 2020 Feb 24];18:64-5. Available from: http://www.cmijournal.org/text.asp?2020/18/1/64/277528




  Introduction Top


Use of contraception has been recommended to prevent pregnancy, to practice family planning, and also to prevent the acquisition of sexually transmitted infections.[1] It is important to advocate that regardless of geographical settings, all the women should have access to the wide range of contraceptives. This will ensure that based on their preferences or values, an appropriate and well-informed choice women can make about the use of contraceptives and their sexual and reproductive health.[1],[2],[3] The use of appropriate contraception among human immunodeficiency virus (HIV)-infected patients is of immense value considering the risk of transmission of infection.[2]


  Earlier Guidelines and Medical Eligibility Criteria Top


To streamline the same, medical eligibility criteria have been formulated to promote usage of contraceptives for people suffering from different health conditions (viz., no restrictions, or the merits of using method are much more than the potential risk, or the risk is more than the merit attributed to the methods) or risks.[2],[4] Based on the individuals or presence/absence of health conditions (such as age, weeks/months postpartum, and breastfeeding status), the contraceptive eligibility is determined.[2],[4] These guidelines have existed for some time now; however, with the emergence of new evidence from a randomized clinical trial performed in high HIV prevalence settings in the four African nations, these recommendations have been revised.[4.5]


  New Recommendations Top


The recent evidence envisages that regardless of the potential risk of acquisition of HIV infection by a woman, she should have full freedom to opt for the contraceptive method of her choice.[5] Taking the issue further, the access to HIV prevention or treatment services should also exist for all women.[1],[5] This can translate to the promotion of the use of condoms, provision of preexposure prophylaxis, contact/partner testing, and linking HIV-positive individuals to antiretroviral therapy.[2],[5] The recent recommendations advocate for providing preexposure prophylaxis in all regions, with the incidence of HIV being more than 3%.[2]

Further, women at high risk of HIV can use any form of reversible contraception, and this can be even in the form of contraceptive implants or intrauterine devices or even the use of progestogen-only injectables.[5] This modification has paved the way for usage of progestogen injectables, which till now were expected to cast negative health consequences among women who are at high risk of acquiring HIV infection.[5] Further, it has been envisaged that women living with severe or advanced forms of HIV should not start the usage of the levonorgestrel intrauterine devices until their illness has improved.[2]

However, it is quite clear that despite the use of these contraceptive methods, the potential risk of acquisition or transmission of HIV or any other sexually transmitted infections is not minimized.[1],[2] Hence, the old age recommendation of promoting the correct and consistent use of condoms stands strong and should be encouraged in all the settings.[2] Moreover, for the successful implementation of these provisions, a multisectoral approach is required, essentially requiring local community support and intensification of advocacy, communication, and social mobilization activities.[1],[6]


  Conclusion Top


In conclusion, the sexual and reproductive health needs of all women are quite variable and it becomes even more challenging for the women who are either at high risk of HIV or HIV positive. The recent recommendations to expand the range of services offered, including contraceptive methods, is an important step, but will also require strengthening of the existing services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shrivastava SR, Shrivastava PS, Ramasamy J. Recommendations to promote safe and effective use of contraceptives: World Health Organization. CHRISMED. J Health Res 2017;4:291.  Back to cited text no. 1
    
2.
World Health Organization. WHO Revises Recommendations on Hormonal Contraceptive Use for Women at High HIV Risk. World Health Organization; 2019. Available from: https://www.who.int/news-room/detail/29-08-2019-who-revises-recommendations-on-hormonal-contraceptive-use-for-women-at-high-hiv-risk. [Last accessed on 2019 Nov 05].  Back to cited text no. 2
    
3.
Raj Y, Sahu D, Pandey A, Venkatesh S, Reddy D, Bakkali T, et al. Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010-2011. Int J STD AIDS 2016;27:1257-66.  Back to cited text no. 3
    
4.
Gaffield ML, Kiarie J. WHO medical eligibility criteria update. Contraception 2016;94:193-4.  Back to cited text no. 4
    
5.
World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 5th ed. Geneva: WHO Press; 2019. p. 1-24.  Back to cited text no. 5
    
6.
Shrivastava SR, Shrivastava PS, Ramasamy J. Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets. Ann Trop Med Public Health 2017;10:509-10.  Back to cited text no. 6
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