Written by Samantha Hyacinth with support from The Well Project
Major advancements in HIV treatment and prevention mean that people living with HIV are no longer limited to condoms for contraception. Most patients with HIV have the full range of contraceptive options.
Studies of couples all over the world show that when a person living with HIV has an undetectable viral load, they do not transmit HIV sexually to their HIV-negative partner, even if they don’t use condoms.i Providers should discuss the importance of adequate HIV treatment/lab monitoring and reassure patients that when it comes to viral load, undetectable = untransmittable. This means that barrier methods, such as internal and external condoms, are not the only viable contraceptive option for people living with HIV; depending on a person’s viral load, barrier methods may not be necessary at all.
Patients should also know that their partners may be appropriate candidates for Pre-Exposure Prophylaxis (PrEP).¹ The availability of once-daily medications emtricitabine/tenofovir disoproxil fumarate (FTC/TDF),ii emtricitabine/tenofovir alafenamide (FTC/TAF),iii and a new bimonthly injectable cabotegravir,iv means that people who are HIV negative now have a variety of biomedical options to help prevent HIV acquisition. It’s important to note that due to a lack of research on its efficacy in the vagina, FTC/TAF has not been approved to prevent HIV acquisition for people having receptive vaginal intercourse.
When discussing contraceptive options with any patient, it’s important to center the patient’s priorities for contraception. For those interested in hormonal options, it’s important to discuss possible medication interactions. According to the CDC’s US Medical Eligibility for Contraceptive Use (MEC), the only contraceptive/antiretroviral combination considered higher than a 2 is fosamprenavir and combined hormonal contraceptives (CHCs). This combination is considered a 3 due to concern that CHCs decrease serum levels/efficacy of fosamprenavir.² Of note, fosamprenavir is an older protease inhibitor that is no longer widely used in clinical practice.³ For more information on the limited data that exists on the interactions between CHCs, DMPA, and antiretroviral therapies, please see: CDC – Potential Drug Interactions: Hormonal Contraceptives and Antiretroviral Drugs – USMEC – Reproductive Health.
The Well Project Resources:
2. US Medical Eligibility Criteria (US MEC) for contraceptive use, 2016. Centers for Disease Control and Prevention. https://www.cdc.gov/
3. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Available at https://clinicalinfo.hiv.gov/
For the months of June, July, and August, RHAP will be working alongside The Well Project to create a summer “string of pearls” series on HIV care and preconception, contraception, and screening.
The Well Project is a non-profit organization whose mission is to change the course of the HIV/AIDS pandemic through a unique and comprehensive focus on cis and trans women and girls. The Well Project envisions a world in which women living with or vulnerable to HIV have the information, support, and tools they need to advocate for their health and well-being, and live free from stigma.
Founded in 2002, The Well Project has become a recognized leader in the fight against HIV by revolutionizing the availability and accessibility of much-needed resources designed specifically for women living with and vulnerable to HIV and by prioritizing the advancement of women in all aspects of HIV prevention, treatment, and cure research and policy.
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.