Both male
and female condoms (Femidoms) are
highly effective at preventing pregnancy, the transmission of HIV and most
sexually transmitted infections. However, they need to be used properly in
order for them to be effective. If you are not sure how to use them, you can
ask for help from your healthcare team. You can also get help from a range of
community-based organisations; for example, you may be able to attend one of
the sexual health and relationship workshops run by the organisation Positively
UK to get more information and support around this topic.
In the UK, HIV
treatment centres and sexual health (GUM) clinics offer both male and female
condoms free of charge.
If a
condom breaks during sex, the emergency contraceptive pill is available to buy
from chemists. You may also be able to obtain free emergency contraception from
a GP, GUM clinic or the accident and emergency department (A&E) of your
local hospital. It’s important you let the doctor or pharmacist know if you are
on HIV treatment, as some anti-HIV drugs interfere with the way the emergency
contraceptive pill works, and you will need to take twice the normal dose. You
need to take the pill within 72 hours of having sex, ideally sooner.
Having an
IUD fitted stops sperm from reaching an egg and fertilising it. It is the most
effective method of emergency contraception and prevents up to 99% of
pregnancies. It is suitable for women with HIV as it doesn’t contain any
hormones. You may want to continue to use it as a long-term form of
contraception. But remember that this type of contraception doesn’t prevent you
passing on HIV or other sexually transmitted infections.
If your
partner is HIV-negative and a condom breaks during sex, they should visit a GUM
clinic or A&E department as soon as possible, and definitely within 72
hours, where they may be prescribed post-exposure
prophylaxis (PEP), a short course of anti-HIV drugs which may be able to
prevent them from becoming infected.
Because
of the need for condoms to be used properly every time to prevent pregnancy,
you may want to use a back-up form of contraception as well.
Several
anti-HIV drugs and antibiotics interfere with the way some hormonal
contraceptives work, and the contraceptive may not be as effective as usual.
Getting advice on possible drug interactions from your doctor or pharmacist is
important.
These
hormonal contraceptives are less effective if you’re taking HIV treatment:
- the combined
pill
- the progestogen-only
pill, also known as the mini-pill
- patches –
a small beige patch applied to the skin like a sticky plaster that is changed
once a week
- implants –
a small flexible rod that is inserted under the skin on the upper part of the
arm, and works for up to three years
- vaginal rings
– a small flexible ring that is inserted in the vagina for three weeks of the
month.
Several
types of contraceptives are not affected by anti-HIV drugs. They are the intrauterine
device (IUD), the Mirena intrauterine system (IUS) and the Depo-Provera
injection.
An
IUD is a small, T-shaped contraceptive device made from plastic and copper that
fits inside the womb (uterus), sometimes called a coil. It releases copper into
the body, causing changes that prevent sperm from fertilising eggs. You will be
offered a sexual health screen, and any sexually transmitted infection (STI)
will be treated before the coil is fitted by a doctor or nurse. It can be
easily removed if it doesn't suit you.
The
Mirena IUS is a small plastic device also fitted in the womb, which contains
hormones that reduce the risk of heavy periods (sometimes stopping them
altogether). It is also used by women with heavy, painful periods as an
alternative to hysterectomy. It must be fitted by a doctor or nurse, after a
sexual health check and treatment of any STI. Once it’s fitted, it works for
five years.
The
most common type of contraceptive injection is called Depo-Provera; it contains
the hormone progestogen and each injection lasts for 12 weeks.
None
of these methods prevent the transmission of HIV or other STIs.
A
number of other medications (e.g. antibiotics) interact with hormonal
contraceptives, so getting advice on drug interactions from your HIV doctor or
pharmacist is important. During the period you are taking any antibiotics, and
for a week after, you are recommended to use an additional form of
contraception if you are using a hormonal contraceptive.
Diaphragms
and caps are flexible rubber or silicone dome-shaped devices which are placed
in the vagina each time you have sex. They are not recommended for women with
HIV, as they should be used with a substance called a spermicide that can irritate
the vagina.
The
National Health Service (NHS) provides free access to contraception; that is,
you do not need to pay a prescription charge. Contraception is available from
general practitioners (GPs), and from sexual health or contraception clinics. Details
of local clinics are available from NHS Direct (tel 0845 46 47 or at www.nhs.uk)
or from the FPA (www.fpa.org.uk/helpandadvice/findaclinic).