Question

Besides condoms, what other contraception can I use?

15 March 2012. Related: All topics, Sexual health.

I am a 40 year old female who has been positive for 4 years. Presently, I am on combination drugs.

Besides condoms, what is the best form of short-term contraception?

Answer

Answer: Angelina Namiba

Thank you for your question.

As there are a number of options available in response to your question, my answer is going to be quite lengthy. I hope you don’t mind.

Besides male and female condoms, there are a number of short term contraceptive options available for women taking ARVs(Antiretroviral treatments for HIV). Some hormonal contraceptives such as the oral contraceptive pill, patch and implants may not be as effective if you are taking ARVs. This is because some ARVs reduce their effectiveness.

The following options  are recommended by the The BHIVA (British HIV Association) guidelines for the management of the sexual health of people living with HIV.

The first option is the Depo contraceptive injection. This is an extremely effective method of contraception for women taking ARVs or using drugs to treat TB. It is given as an injection every 12 weeks and therefore you can link this with your clinic visits.

You did not specify ARVs you are taking. However, as HIV infection itself and some ARVs have been linked to reduced bone thickness, it may not be the best choice for teenagers with growing bones, or older women who may start to lose bone thickness. If, after discussion you choose to go ahead with this method, then  your doctor can perform a test which measures bone thickness prior to starting, if you have concerns about this. The important thing to note is that it may take upto a year for fertility to return after stopping Depo.

The second option is the Mirena coil which is a hormone releasing system that can be used by both women who are taking or not taking ARVs. The coil is inserted into the uterus and in the clinic setting and can remain for upto 5 years. It is an extremely effective form of contraception and can be removed when you are planning pregnancy.

The third option are other IUDs (Intrauterine devices), or coils, which do not release hormones and are also safe and effective methods of contraception for women living with HIV regardless of whether they are taking ARVs or not. IUDs are effective for 3-10 years depending on the type. A full sexual infection screen should be performed before both the Mirena or to IUDs can be inserted.

Finally, if you haven’t started using contraception and have an ‘accident’, then you have the option to use  EC (emergency contraception).The two main methods available are: ‘the morning after’ pill which must be taken within 72 hours of the unprotected sex. For women on ARVS, the recommendation it to take a double dose of 3mg; or the insertion of a copper IUD up to 5 days after sex. This is the preferred option for women taking ARVs as this method is not affected by other drugs.

Best wishes.