Background Epidemiologic research has yielded inconsistent evidence on whether use of hormonal contraception (HC) increases women’s risk of HIV acquisition. A robust meta-analysis of existing data can yield a valid summary estimate to inform guidelines, models and future studies. Methods We updated a recent systematic review to identify studies examining the relationship between various HC methods and women’s risk of HIV. We assessed statistical heterogeneity, and, when appropriate, combined point estimates using random effects models. We explored heterogeneity through subgroup and stratified analyses according to study populations and design features. Findings We identified 26 studies, 12 of which met inclusion criteria. There was evidence of a modest increase in HIV risk in the ten studies examining depot-medroxyprogesterone acetate (DMPA) [pooled relative risk (RR) =1.40, 95% CI: 1.16, 1.69]. This risk was lower in the eight studies conducted with women in the general population [pooled RR=1.31, 95% CI: 1.10, 1.57]. There was substantial between study heterogeneity in secondary analyses of trials (n=7, I2=51.1%). Although individual study estimates suggested an elevated risk, substantial heterogeneity between the two studies conducted with high risk women (I2=54%) precluded pooling estimates. There was no evidence of an elevated HIV risk in the ten studies examining oral contraceptive pills (OCPs) [pooled RR = 1.00, 95% CI: 0.86, 1.16] or the five studies examining norethisterone enanthate (Net-En) ([pooled RR=1.10; 95% CI: 0.88, 1.37]. Interpretation The risks of HIV found here would not merit complete withdrawal of DMPA, OCPs, or Net-En from the contraceptive method mix in most settings for women in the general population.

Social network HTC strategies may increase demand for HTC and efficiently identify PLHIV. The flat incentive was as successful as the conditional incentive for recruiting high-risk individuals. Unexpectedly, this method also reidentified PLHIV aware of their status.

The paper reviews data on HIV testing, treatment, and care outcomes for women who use drugs in five countries across five continents. We chose countries in which the HIV epidemic has, either currently or historically, been fueled by injection and non-injection drug use, and that have considerable variation in social structural and drug policies: Argentina, Vietnam, Australia, Ukraine, and the United States. There is a dearth of available HIV care continuum outcome data (i.e., testing, linkage, retention, ART provision, viral suppression) among women drug users, particularly among non-injectors. While some progress has been made in increasing HIV testing in this population, HIV-positive women drug users in four of the five countries have not fully benefitted from ART nor are they regularly engaged in HIV care. Issues such as the criminalization of drug users, HIV-specific criminal laws, and the lack of integration between substance use treatment and HIV primary care play a major role. Strategies that effectively address the pervasive factors that prevent women drug users from engaging in HIV care and benefitting from ART and other prevention services are critical. Future success in enhancing the HIV continuum for women drug users should consider structural and contextual level barriers and promote social, economic and legal policies that overhaul the many years of discrimination and stigmatization faced by women drug users worldwide. Such efforts must emphasis the translation of policies into practice and approaches to implementation that can help HIV-infected women who use drugs engage at all points of the HIV Care Continuum.

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