Chapter 22
Contraceptives for Clients with STIs, Including HIV
People with STIs and HIV (regardless of whether they are taking ART) can start and continue to use most contraceptive methods safely. There are a few limitations, however, as described in the table below. Each contraceptive method chapter in this Handbook (Chapters 1–20) also provides more information and considerations for clients with HIV, including those taking ART.
Special Family Planning Considerations for Clients with STIs, including HIV
| Method | Has STIs | Has HIV |
|---|---|---|
| Intrauterine device (IUD): copper-bearing IUD (Cu-IUD) or levonorgestrel-containing IUD (LNG-IUD) |
Do not insert an IUD in a client who is at very high individual risk for gonorrhea and chlamydia, or who currently has gonorrhea, chlamydia, purulent cervicitis, or pelvic inflammatory disease (PID). However, a current IUD user who becomes infected with gonorrhea or chlamydia or develops PID can safely continue using the IUD during and after treatment for the infection. |
A client living with HIV clinical disease that is mild or with no symptoms (WHO Stages 1 or 2), including a client on antiretroviral therapy (ART), can have an IUD inserted. Generally, a client should not have an IUD inserted if they have HIV clinical disease that is severe or advanced (WHO Stages 3 or 4). A current IUD user who becomes infected with HIV or whose HIV clinical disease becomes severe or advanced (WHO Stages 3 or 4) can safely continue using the IUD. A client using an IUD can keep the IUD in place when they start ART. |
| Female sterilization | If the client has gonorrhea, chlamydia, purulent cervicitis, or PID, delay sterilization until the condition has been treated. |
Clients living with HIV, including those on ART, can safely undergo vasectomy. The procedure may need to be delayed in clients with severe or advanced HIV clinical disease (WHO Stages 3 or 4) if the client currently has an HIV-related illness. |
| Vasectomy | If client has scrotal skin infection, active STI, or swollen, tender tip of penis, sperm ducts, or testicles, delay sterilization until the condition is treated and cured. |
Clients living with HIV, including those on ART, can safely undergo vasectomy. The procedure may need to be delayed in clients with severe or advanced HIV clinical disease (WHO Stages 3 or 4) if the client currently has an HIV-related illness. |
| Spermicides | Can be used. |
Generally, clients living with HIV should not use spermicides (the risks usually outweigh the advantages). |
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All hormonal methods (except hormone-releasing IUDs) can be used by any client with STIs, including HIV. |
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