[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:
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.
To share other relevant articles, resources or tools on this topic please contact the Health COMpass curator, Susan Leibtag, susan.leibtag@jhu.edu. To share your thoughts on this topic, please connect with us through SpringBoard (link to evidence review post). We welcome your contributions!
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.
Press Releases
January 10, 2018. Child, Katherine. Growing concern over HIV risk from contraceptive injection. South Africa Times, "Times Live."
August 9, 2016: New Review of Evidence on Hormonal Contraceptive Methods and Risk of HIV Acquisition in Women Underscores Differences Between Methods.
Banner photo: A health worker tests a client for HIV at Eduardo Mondlane Health Center in Chimoio, Mozambique. © 2015 Arturo Sanabria, Courtesy of Photoshare
This framework:
This is a list of frequently asked questions (FAQs) about how the World Health Organization developed its guidelines for hormonal contraception and women at high risk for HIV, as well as basic facts about this issue. Some of the questions are:
This Compendium is built around the different themes in the theory of change and includes a focused set of indicators and related assessment tools that have direct and indirect relevance to tracking the links between SRH and HIV programmes at national and sub-national levels.
The World Health Organization (WHO) convened a technical consultation during 1–2 December 2016 to review new evidence on the risk of HIV acquisition with the use of hormonal contraception.
This update summarizes current evidence and the World Health Organization (WHO) revised guidance regarding the use of hormonal contraception (HC) by women at high risk of acquiring HIV.
The update lists the following guidance:
Women at high risk of HIV should not be restricted from using progestogen-only injectables.
In this webinar, panelists discussed what the WHO grading system for family planning methods is, what impact a change in classification for DMPA and NET-EN has for women, programs and research, and what needs to happen next.
The panelists included:
This course will explain the benefits of integrating family planning (FP) into HIV services and provide guidance on how to establish and sustain the delivery of integrated FP/HIV services.
This tool is part of MEASURE Evaluation's Reproductive Health Indicators Database, focusing on the programmatic area of family planning (FP) and HIV .
This May 17, 2016 webinar, moderated by Nithya Mani, Division Chief, Implementation Support, Office of HIV/AIDS, USAID, introduced the framework, provided discussion around the adaptation process in Malawi and Swaziland, and included the perspective of women living with HIV related to this issue.
The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is an open-label randomized clinical trial that aims to compare three highly effective, reversible methods of contraception—the progestogen-only injectable depot m
This job aid is part of the Family Planning Global Handbook. It provides counseling tips for service providers working with clients who are at risk for HIV.
This presentation describes how and why the Malawi Ministry of Health adapted the Strategic Communication Framework for Hormonal Contraceptive Methods and Potential HIV-Related Risks for use in their countr
The Swaziland Ministry of Health was interested in adapting the Strategic Communication Framework for Hormonal Contraceptive Methods and Potential
This introductory 3-page document summarizes the debate over whether certain hormonal contraceptives increase women’s risk of HIV acquisition.
This is an information sheet for consumers about the hormonal contraceptive known as Depo-Provera (DMPA) and the WHO grading system for contraceptives explains key issues in plain language.
This pamphlet was designed for women considering using Depo-Provera as a contraceptive method.
It provides important information about the relationship between Depo-Provera and HIV, about taking Depo when using ARVs, and about protecting oneself and one's partner from HIV.
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