[UPDATED June 13, 2019] In a study reported on this date in The Lancet, the results of the ECHO (Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium)study which was designed to determine the relationship between some hormonal contraceptive methods and HIV reported that there is no significant difference in HIV rates between those women who used hormonal contraception and those who did not.
Communication plays a critical role in providing women and their partners with the information needed to inform contraceptive method selection. Recently, framing that information (Strategic Communication Framework for Hormonal Contraceptive Methods and Potential HIV-Related Risks) in a clear, consistent, and complete manner has become challenging as ambiguity around risks associated with use of long-acting progestogen-only injectables remains.
Cumulative observational evidence (Polis, 2016) indicates a possible increased risk of HIV acquisition in women using progestogen-only contraceptive methods. While randomized control trials (ECHO) are currently underway to determine whether there is a causal relationship between progestogen-only injectable and risk of HIV acquisition, efforts are being made to ensure women, their partners, providers, and communities are aware of the potential increase in risk and have access to the methods of their choice and HIV preventive measures.
In December 2016, the WHO convened a meeting of its Guidelines Development Group to review new evidence and, where appropriate, revise specific recommendations. The following recommendations emerged:
- Women and couples at high risk of HIV infection continue to be eligible to use all forms of hormonal contraception
- Informed decision-making is a key organizing principle and standard in a human rights-based approach to contraceptive information and services
- A shared decision-making approach to contraceptive use should be taken with all individuals, but special attention should be paid to using this approach with vulnerable populations, such as women at high risk of acquiring HIV
- Women at high risk can use the following hormonal contraceptive methods without restriction (MEC category 1): combined oral contraceptive pills (COCs), combined injectable contraceptives (CICs), combined contraceptive patches and rings, progestogen-only pills (POPs), and levonorgestrel (LNG) and etonogestrel (ETG) implants
- Women at high risk of acquiring HIV can generally use progestogen-only injectables (NET-EN and IM or SC DMPA) (MEC category 2), but there must be clear provision of information beforehand to enable informed decision-making. There continues to be evidence of a possible increased risk of acquiring HIV among progestogen-only injectable users
- Women considering progestogen-only injectables should be advised about the uncertainty over a causal relationship, and about how to minimize their risk of acquiring HIV
This Trending Topic offers an Evidence Review, peer-reviewed literature, and a selection of tools and other materials related to social and behavior change (SBC) aspects of addressing the relationship between hormonal contraception and HIV.
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Journal Articles / Technical Papers
Mallieu, Elizabeth C., et al. (2018) Strategic Communication for Hormonal Contraception and HIV: An Evidence Review. 1 March 2018.
Hapgood, Janet. (2018) Hormonal Contraception and HIV-1 Acquisition: Biological Mechanisms. Endocrine Reviews (39:1) 1 February 2018, 36–78,
Shen, Z., et al. (2017). Hormonal Contraceptives Differentially Suppress TFV and TAF Inhibition of HIV Infection and TFV-DP in Blood and Genital Tract CD4+ T cells. Scientific reports, 7(1), 17697.
Riley Halley E.M, et al., (2017) Hormonal contraceptive methods and HIV: research gaps and programmatic priorities, Contraception (96), 67-71.
McLaughlin, M. (2017). Prevalence of Drug-drug Interactions with Hormonal Contraceptives and Antiretrovirals in Women Living with HIV. Methods, 1, 1-4.
Polis, C. B., (2016). An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women. AIDS (London, England), 30(17), 2665.
Wall, K., et al. (2016) Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994–2012. Journal of Infectious Diseases, October 2016; 214(7), 1063–1071.
Morrison C.S., et al., (2015) Hormonal Contraception and the Risk of HIV Acquisition: An Individual Participant Data Meta-analysis, PLoS Med, 2015, 12(1): e1001778.