Changes to the World Health Organization guideline on hormonal contraceptive eligibility for women at high risk of HIV: South African perspective and response

Abstract

The World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March 2017. This guidance followed from a technical consultative meeting convened by the WHO in December 2016, where all the available evidence on hormonal contraceptives and risk of HIV acquisition was reviewed. This was an expert meeting with representation from global experts in family planning and HIV management, including clinicians, epidemiologists, researchers and civil society. The guideline development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from category 1 to category 2 for progestogen-only injectable contraceptives among women at high risk of HIV. There was no change in the recommendation for all other methods of hormonal contraception. The data that informed this decision are from observational studies, which have limitations; therefore, causality or association of hormonal contraception and risk of HIV acquisition have not been proven. This guidance will have an impact on countries that have a high HIV disease burden and where progestogen-only injectable contraceptives are the highest used, as in South Africa (SA). The information has to be communicated in line with the WHO's sexual and reproductive health rights principles of ensuring that all women should receive evidence-based recommendations. This will empower them to make informed choices about their reproductive needs. This article seeks to clarify the decision-making process of the WHO and how the new recommendations were formulated. It also gives SA's response to the guidance and a perspective of what informed the National Department of Health's position, taking into account the effect this will have on SA's contraceptive guidelines.

The role of neutrophil activation in determining the outcome of pregnancy and modulation by hormones and/or cytokines

“…In the context of the above findings, it would be worthwhile clarifying whether the use of injected contraceptives associated with a moderate increased risk for HIV-1 infection in high-risk populations [43,44] may be due to altered PMN behaviour in the FRT.…”

Medroxyprogesterone Acetate Decreases Th1, Th17, and Increases Th22 Responses via AHR Signaling Which Could Affect Susceptibility to Infections and Inflammatory Disease

“…For this reason, the World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March 2017. The guideline development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from category 1 (condition for which there is no restriction for the use of the contraceptive method) to category 2 (condition where the advantages of using the method generally outweigh the theoretical or proven risks) for Depo-MPA among women at high risk of HIV acquisition (68).…”

Pharmaceuticals and modern statecraft in South Africa: the cases of opium, thalidomide and contraception.

“…This generated intense debate about continued provision of hormonal contraceptives, particularly injectables, as the most popular method for women in the public health sector 62. In addition, public scandals over the incidence of teenage pregnancy, illegal abortion and ‘baby dumping’ raised questions about the effectiveness of the state’s transition from ‘population control’ to ‘reproductive rights’ 63–67. The prevalence of teenage childbearing has remained relatively high in the post-Apartheid era.…”