Women of reproductive age are disproportionately affected by HIV/AIDS globally, at risk for both unintended pregnancy and HIV infection. So it stands to reason that both issues should be simultaneously addressed by governments, health care providers, advocates, and donors. A burgeoning partnership between the HIV/AIDS and family planning sectors led to a well-attended session at the International AIDS Conference in Amsterdam in late July. The session: “Hormonal Contraception and HIV Risk at the Crossroads: What do the latest research, advocacy, and program developments mean for women, providers, and programs?” was co-chaired by AVAC and FP2020. Panelists, including FP2020 Executive Director Beth Schlachter, addressed the synergies of HIV and unintended pregnancy prevention as well as questions about the ECHO trial results expected in 2019.
There is evidence from observational studies that use of progestogen-only injectable contraceptive methods — particularly depo-medroxyprogesterone acetate (DMPA) — is associated with an increased risk of acquiring HIV infections. But uncertainty remains about whether DMPA use actually causes increased risk. The World Health Organization has determined that women at high risk of HIV infection may use DMPA because the benefits outweigh the possible risk, but that more research is needed. Data on whether use of contraceptive implants or IUDs affects HIV risk are also limited. The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is designed to address this critical knowledge gap.
“For as long as we’ve had the HIV epidemic, discussions about integrating the two communities have taken place,” explains Mitchell Warren, AVAC’s Executive Director. “A young woman at risk of HIV has enormous reproductive health needs, but we see so many programs that only deal with one aspect of her health. That’s why the discussion at the AIDS conference was so important, and we couldn’t have it without FP2020. No matter what the results of the ECHO trial are, there are things we should have been doing for years: making sure that contraceptive method mix and informed choice are a reality for all women and girls.”
Beth Schlachter agrees, and highlighted that meeting the needs of adolescents and youth is the key to staying ahead of the HIV epidemic. “Women and girls aged 15–24 account for more than 70 percent of new HIV infections in sub-Saharan Africa, where millions of young people are entering their reproductive years,” she points out. For many of them, preventing pregnancy is a more immediate concern than preventing HIV. If the ECHO trial results show that one of the three contraceptive methods tested leads to higher HIV rates, these young women will have to make difficult choices. “We have to do a better job of explaining complexity so women and girls can make their own decisions,” says Mitchell Warren.
Integrating family planning and HIV services is a good start, and is gaining traction. The Interagency Working Group on Linkages between sexual and reproductive health and rights and HIV (IAWG SRHR/HIV), in collaboration with the IBP Initiative, plans to hold a webinar series to share updates on key activities and resources. The first webinar is scheduled for September 13.
When the ECHO trial ends (anticipated sometime in early 2019) FP2020 will partner to ensure study findings and recommendations are widely disseminated in the global health community, with country partners, and to the women and girls who need this information most.