How to choose a contraceptive if you live with HIV
Thanks to antiretroviral treatments, today people with HIV have the opportunity to decide whether or not they want to have children, since, if they want to start a family, the right treatment will help the baby to be born free of the virus.
And on the contrary, if currently, for whatever reason, you do not want to get pregnant, as a woman living with HIV there are some points that you should take into account when choosing a contraceptive method.
You should know that some contraceptives could be affected by your antiretroviral treatment, which is why this should be the first item on your list when consulting with your medical team, according to the specialized website Aidsmap.com.
In addition, other elements should be considered like: which method best suits your lifestyle, how often you would like to use it, how long you want to wait to get pregnant (or if you no longer want to), and what are the side effects of each method.
With these points already defined, you can speak with the health personnel in a clear way about your needs, doubts and preferences.
Hormonal methods and your treatment
Hormonal contraceptives work by preventing ovulation and by thickening cervical mucus (to make it harder for sperm to pass through). Hormonal methods have various presentations:
• Pills
• Patches
• Vaginal rings
• Injections
• Implants
• Intrauterine devices or IUDs (some types of them)
Many of the antiretroviral drugs can interfere with hormonal methods, reducing their effectiveness. This happens because both the HIV treatment and these contraceptives are processed by the same enzymes in the liver, which causes the contraceptive to be processed faster than it should, leaving a level too low in the body to effectively prevent pregnancy. The antiretroviral treatment, however, would continue to work properly, so it would not be affected.
But if these types of (highly effective) methods are what you believe will work the best for you, you can talk with your doctor whether it is possible to change the antiretroviral drug that would be affecting the contraceptive. Keep in mind that other non-HIV medications can also interfere with contraception. If you have doubts, ask your doctor.
Most effective options
Not all antiretroviral interfere with contraception. Also, there are methods that don’t include hormones, so you have a few more options if you don’t want to use a hormone and/or if you don’t want to or can change your HIV treatment.
The IUD is an option that has been widely used. It is a “T” shaped device that is inserted into the uterus and, due to the release of copper, prevents the sperm from fertilizing the female egg. For many women it is comfortable because it does not contain hormones and it can also last between five and ten years.
Another type of intrauterine device (also called an “intrauterine system”) is made of plastic and does release hormones. It is also placed in the uterus, but has the advantage that it is not affected by antiretroviral treatment. This device lasts up to five years.
Take care of your bone health
Contraceptive injections, which must be given every 13 weeks, can have a major impact on bone loss. While, in general, they cause a slight loss of this mass, in women with HIV this reduction may be marked some more, since the antiretroviral drug Tenofovir has the same negative effect, so using both drugs could worsen the situation.
Remember that both your reproductive health and your HIV treatment are important and, above all, they are your right. Talk to your health team about the options you have and choose the one that best suits you.
At AHF Latin America and the Caribbean we work for quality health services related to HIV. If you already have a positive diagnosis and you have not started your treatment or want to resume it, we can help you. Just come to one of our offices or write to us on Whatsapp, we are in 11 countries in the region.