Nine out of ten women and girls receiving
care for HIV in the UK are of reproductive age.1 Many women with HIV
have a very strong desire to have children, and the availability of effective
measures to prevent mother-to-child transmission has enabled thousands to do so
safely. Indeed, questions about conception and pregnancy tend to figure highly
on the list of HIV-positive women’s concerns.
But what about contraception? A woman with HIV – like any other woman – may wish
to delay pregnancy for a more suitable time, to limit her number of children,
or to avoid pregnancy altogether, and so will need advice and access to
Two small studies at this year’s BHIVA
conference found that between a third and a half of heterosexuals with HIV were
not planning to have a child in the future.2,3
Getting appropriate information and advice
on contraception is especially important because some types of hormonal
contraceptives can be affected by antiretroviral drugs. In general, the
contraceptives become less effective, while the antiretrovirals themselves are
Dr Sharon Moses works in sexual and
reproductive health in Leicester. “We had a
couple of women who came to the clinic, didn’t disclose that they were HIV
positive, asked for their preferred contraceptive method, and then came back
pregnant,” she says.
works more closely with the HIV clinic in Leicester
and raises awareness among her immediate colleagues of the specific needs of
women with HIV.
Of course, an HIV-positive woman’s choice
of contraception may be affected by her desire to avoid HIV transmission as
well as pregnancy.
As Ursula Harrisson, Clinical Lead for HIV
Women's Services at the Chelsea and Westminster Hospital, comments, “A lot of women are
quite happy using condoms. They see them as being a perfectly reasonable
non-hormonal contraceptive that will give protection against HIV transmission
and sexually transmitted infections, as well as pregnancy.”
However, some contraceptive specialists
feel that condoms are a relatively ineffective method. When couples use them
consistently and according to instructions, around 2% of women are still likely
to become pregnant in a year. Many people find that they are less effective
than that, because they don’t follow all the instructions on the pack or are
not able to use them each and every time.
Many other contraceptive methods are more
reliable. For example, contraceptive injections have a failure rate of 0.3%,
and when the combined pill is taken with perfect adherence, the failure rate is
At the same time, it seems that not all
women with HIV are getting information about the full range of contraceptive
methods, perhaps because it is thought that condoms and female condoms are the
only appropriate methods to use.
“Service users say they often feel that
they are not allowed to use hormonal contraceptives because of being HIV
positive, nor are they advised of any other contraceptives except condoms” say
Beatrice Osoro and Stella Gwimbi from Positively Women.
Gráinne Cooney is a nurse practitioner in
sexual and reproductive health at the Chelsea
and Westminster Hospital
in London. She
says that women are always advised to use condoms, but “in reality, women may not
always use them, either through choice or due to pressures in a relationship”.
Given that a condom may break – or that a
partner may refuse to use one – many women choose a strategy of ‘double
protection’ and use condoms in addition to another, more reliable, form of
Gráinne tells us that women often say “I
just want to be absolutely sure – if we have an accident, I want to have
something else on board that will protect me against unplanned pregnancy”.