Abstract
Among the 1.9 billion women of reproductive age worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception. For women and adolescent girls living with human immunodeficiency virus (HIV), using effective contraception reduces the mother-to-child transmission of HIV by preventing unintended pregnancies and enabling the planning and safer conception of desired pregnancies with optimal maternal and child health outcomes. The World Health Organization (WHO) recommends that sexual and reproductive health services, including contraception, may be integrated within HIV services. Integration is associated with increased offers and uptake of sexual and reproductive health services, including contraception, which is likely to result in improved downstream clinical outcomes. Integrating HIV and sexual and reproductive health services has been found to improve access, the quality of antenatal care and nurse productivity while reducing stigma and without compromising uptake of care. Research is encouraged to identify approaches to integration that lead to better uptake of sexual and reproductive health services, including contraception. Implementation research is encouraged to evaluate different strategies of integration in different health systems and social contexts; such research should include providing contraception, including long-acting contraception, in the context of less frequent clinical and ART refill visits.
Highlights
Among the 1.9 billion women of reproductive age (15–49 years old) worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception
Evidence indicates that sex workers are at higher risk of both acquiring human immunodeficiency virus (HIV) and having an unintended pregnancy, have a greater unmet need for contraception than the general population, rely excessively on using condoms alone instead of the recommended dual protection, and face stigma from health care providers [1,2,3,4,5]
For women and adolescent girls living with HIV, using effective contraception reduces the mother-to-child transmission of HIV by preventing unintended pregnancies and enabling the planning and safer conception of desired pregnancies with optimal maternal and child health outcomes [6]
Summary
Among the 1.9 billion women of reproductive age (15–49 years old) worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception. For women and adolescent girls living with HIV, using effective contraception reduces the mother-to-child transmission of HIV by preventing unintended pregnancies and enabling the planning and safer conception of desired pregnancies with optimal maternal and child health outcomes [6]. Since women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities and from the health-care institutions in which they seek care, particular emphasis is placed on creating an enabling environment to support more effective health interventions and better health outcomes [8]. WHO recommends the integration of HIV services, including HIV testing services (HTS), with a range of other relevant clinical services, such as those for TB, maternal and child health, sexual and reproductive health, harm reduction programmes for people who inject drugs and, in priority countries, voluntary medical male circumcision (VMMC) programmes [9]. WHO recommends that, with the exception of advanced HIV disease, women living with HIV can generally use any contraceptive method [13]
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