|Key Points for Providers and Clients|
* Repeated and high-dose use of nonoxynol-9 spermicide has been found to be associated with increased risk of genital lesions, which may increase the risk of acquiring HIV (see Chapter 16, Question 3). For this reason, the MEC category for spermicides and diaphragms is Category 4 (i.e. “Method not to be used”) for women who are at high risk of acquiring HIV (see Appendix D: Medical Eligibility Criteria for Contraceptive Use).
† >= 5% HIV prevalence.
†† <5% HIV prevalence
Some adolescents and women are at high risk for acquiring HIV. Family planning providers must recognize this in order to provide high-quality family planning services. As shown in the map below, the incidence of HIV infection is especially high among adolescents and women in parts of East and Southern Africa.
Adolescents and women at high risk for HIV can safely use all family planning methods, with the exception of nonoxynol-9 spermicides. Family planning providers should also support adolescents and women to access HIV testing (including HIV self-tests) for themselves and their partners, as well as prevention services and care when indicated. Adolescents and women who are at risk for HIV may also be at risk of gender-based violence, including sexual violence, force, or coercion. If a provider suspects this is the case, or if a client discloses this information, refer to the section in Chapter 24 on Violence Against Women for information on how to support and care for the client. The client may also be at increased risk of acquiring an STI, including human papillomavirus (HPV). For more detailed information on STIs, including HPV, please see Chapter 22 on Sexually Transmitted Infections, Including HIV.