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Questions and Answers about Family Planning for Adolescents and Women at High Risk for HIV
1. Is it safe for women at high risk for HIV to use hormonal contraceptives?
Yes, all family planning methods, including hormonal methods, are considered safe to use for all women regardless of HIV risk, in the absence of any other medical or physiological contraindications. The only exception is the spermicide nonoxynol-9, which should not be used by women at high risk for HIV.*
2. What does a reactive (“positive”) HIV self-test result mean?
The HIV self-test (HIVST) is for screening only and does not provide a definitive HIV-positive diagnosis. An HIVST shows either reactive (“positive”) or nonreactive (“negative”) results. A reactive (“positive”) HIVST result is not a positive HIV diagnosis. Everyone with a reactive (“positive”) HIVST result needs additional testing by a trained provider in order to diagnose HIV, starting with the first test in the national testing algorithm. An invalid HIVST result means that the test needs to be repeated with another new HIVST kit. Any person uncertain about their HIVST result should be encouraged to seek testing from a trained provider.
3. What does a non-reactive (“negative”) HIV self-test result mean?
A non-reactive (“negative”) HIV self-test (HIVST) result can be considered to be a correct negative result. There is no need for immediate follow-up or further HIV testing (except for those taking pre-exposure prophylaxis [PrEP]). If the client is at high risk of acquiring HIV, they can take measures to remain HIV-negative (such as HIV risk-reduction counseling, PrEP screening, or taking PrEP). An invalid HIVST result means that the test needs to be repeated with another new HIVST kit. Any person uncertain about their HIVST result should be encouraged to seek testing from a trained provider.
4. Why are HIV self-tests useful?
Despite not giving a definitive positive diagnosis, HIV self-testing (HIVST) is an important screening tool and a good option for many people as it provides a convenient and confidential method of HIV testing. HIVST is an effective way to reach people who may not otherwise get tested for HIV, including adolescents and key populations.‡
5. Is it safe to become pregnant on PrEP?
Yes. PrEP is a safe and effective way to prevent HIV when trying to conceive. Many HIV serodiscordant couples (where one partner is HIV-positive and virally suppressed on antiretroviral therapy, and the other is HIV-negative) desire pregnancy, and use of PrEP can be considered as a strategy for safer conception. Thus, women at high risk of HIV acquisition who are trying to conceive should be offered PrEP for as long as needed, in order to prevent HIV infection. PrEP does not prevent pregnancy or other STIs. (See Chapter 22 – Sexually Transmitted Infections, Including HIV, section on Safer Conception for HIV Serodiscordant Couples).
6. Is it safe to take PrEP when pregnant or breastfeeding?
Yes. Taking PrEP is safe for women who are pregnant or breastfeeding. PrEP is a combination of antiretroviral medicines that may be taken by pregnant and breastfeeding women without any problems for the woman or her baby.
In sub-Saharan Africa, HIV infection can occur at high rates during pregnancy, and the risk of passing HIV on to a baby is higher if the mother contracts HIV while she is pregnant. PrEP is a safe and important option for preventing HIV among pregnant women and their babies.
7. How long can a woman take PrEP?
Adolescents and women can safely take PrEP for as long as they are at risk for HIV. They should be tested for HIV every 3 months to make sure they are still HIV-negative while taking PrEP. If a person tests HIV-positive while taking PrEP, they should be referred to antiretroviral therapy (ART) services immediately.
8. Does PrEP reduce the effectiveness of hormonal contraceptives?
No. PrEP does not affect the effectiveness of hormonal contraceptives, and hormonal contraceptives do not affect the effectiveness of PrEP. This is because the medicines in PrEP do not change levels of hormonal contraceptives in the body. PrEP is safe to take with any method of contraception, and any method of contraception is safe to use with PrEP.
9. What does it mean to be in the “window period”?
The “window period” is a short period of time (usually less than 3 weeks) when a person has contracted HIV but has not yet developed an immune response (anti-HIV antibodies) to the virus. Since HIV tests detect anti-HIV antibodies, a standard HIV testing algorithm could indicate that a woman is negative during the “window period” when she is actually HIV-positive (she does have HIV in her body). If a woman has had a recent HIV exposure and she tests negative for HIV, she should get another test in 2 weeks to confirm her HIV status.
* 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 – Spermicides and Diaphragms, 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).
‡ Key populations are “defined groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context”. For a more complete definition, see: Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/handle/10665/246200).