Contraception the Best Kept Secret in HIV Prevention

1
Contraception the Best Kept Secret in HIV
Prevention

• XVII International AIDS Conference
• August 3, 2008
• Rose Wilcher
• Family Health International

2
Protect Womens Rights

• All women have the right
• To decide freely and responsibly on the number
  and spacing of their children and to have access
  to the information, education and means to enable
  them to exercise these rights.

Source Convention on the Elimination of All
Discrimination against Women
3
Protect Womens Health

• Family planning
• Delays first births
• Lengthens birth intervals
• Reduces the total number of children born to
  one woman
• Prevents high-risk and unintended pregnancies
• Reduces the need for unsafe abortion

Source USAID
4
HIV and Unmet Need for Contraception
Sources Guttmacher Institute, 2007, and PEPFAR,
2007
5
Women with HIV Have Unintended Pregnancies

• 84 unintended pregnancies among PMTCT clients in
  South Africa
• 51 unintended pregnancies among women with HIV
  in Cote dIvoire
• 74 unintended pregnancies among women in HIV
  care in Rwanda

Sources Rochat et al., JAMA 20062951376-8
Desgrées-du-Loû et al., Int J STD AIDS
200213462-468 Bangendanye, 3rd Peds CLS 2007.
6
Four-phase Strategy for Perinatal HIV Prevention
Prevention of HIV in women, especially young
women
Prevention of unintended pregnancies in
HIV-infected women
Prevention of transmission from an HIV-infected
woman to her infant
Support for mother and family
Phase 1
Phase 2
Phase 3
Phase 4
7
Contraception as HIV Prevention Compared to ART
(15 PEPFAR countries)
8
Traditional Family Planning Programs Prevent MTCT
Source Reynolds et al, Sexually Transmitted
Diseases, 200633(6)350-356.
9
FP in PMTCT Programs Prevents MTCT
Source Stover et al. 2004 http//www.usaid.gov/o
ur_work/global_health/pop/news/issue_briefs/pmtct_
issue_brief.pdf
10
What is the Current Benefit of Contraceptive Use
in Tanzania?
9,273,961 women 15-49

• 22.5 CPR
• 6.5 HIV prevalence

614,115 unintended pregnancies averted by current
contraceptive use
39,917 unintended pregnancies averted to HIV
women
11,975 HIV infections prevented to infants per
year
Source Reynolds et al., Sex Transm Infect,
forthcoming
11
What is the Potential Benefit of Contraceptive
Use in Tanzania?
99,775 births to HIV women
23,447 unintended births to HIV women

• 24 of births are unintended

7,034 unintended HIV births
Source Reynolds et al., Sex Transm Infect,
forthcoming
12
Cost Savings to Prevent Unintended Pregnancies
Among HIV Women in Tanzania
13
Contraception The BEST KEPT SECRET in HIV
Prevention

• Effective contraception for HIV-infected women
  who do not wish to become pregnant
• Prevents more infants becoming infected than
  NVP
• Decreases the number of future orphans
• Is a cost-effective HIV prevention intervention
• Key Question how best to achieve FP/HIV
  linkages?