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Contraceptives: Understanding the mystery surrounding Depo and HIV

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Added 26th September 2018 01:26 PM

Making sure that you do not fall pregnant when you are not ready is very important.

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Making sure that you do not fall pregnant when you are not ready is very important.

By Martha Akello

As we commemorate this year’s World Contraceptives day (October 26th, 2018), let us take a look at the mystery that surrounds Depo and HIV.

On such days we get to hear much about the benefits of FP, but rarely do we get to know about some key findings surrounding some methods like DMPA.

DMPA is the famous Depo that many women rely on for family planning in sub Saharan Africa. It is an injection or that very convenient ‘shot’ that women get for three months from a clinic or a health care worker.

Once injected into a woman’s arm or buttock, it protects her from falling pregnant for the next three months. It works well for most women but can also have some side effects. Studies jointly sponsored by FHI 360, the Wits Reproductive Health and HIV Institute (RHI), and the University of Washington suggest that women using Depo might be more likely to get HIV, if they are exposed to the virus. More research is being done to find out if this is true. The World Health Organisation is a partner on the study, along with investigators from the Kenya Coast Provincial Hospital/ International Centre for Reproductive Health, the Kenya Medical Research Institute, the University of Fort Hare and the University of Zimbabwe.

The World Health Organisation (WHO), which is in charge of figuring the safety of different family planning methods on March 2, 2017, changed the safety grade assigned to Depo and another method called NET-EN that is also injected. WHO’s decisions and advice have an effect on what medicines and health supplies the member countries give to their people.

Since 1996, the WHO has used a grading system for family planning called the Medical Eligibility Criteria or MEC. It is used to make sure that family planning programmes around the world use products in the same way. Part of the MEC is a grading system that shows how safe each family planning method is and suggests who can use it:

MEC 1 = this method can be used safely by anyone.

MEC 1* = this method can be used safely by anyone. But there are key things for women and health care workers to think about.

MEC 2 = this method may be risky for some people. For most, it works well enough to be worth it.

MEC 3 = people are likely to have problems with this product. It may not be worth the risk.

MEC 4 = this method should not be used by anyone. It is too risky

MEC 1-4 are the four main ratings. Until now, both Depo and NET-EN have been graded as MEC 1*. This meant that they could be used freely. The “*” was WHO’s way of pointing out that women at high risk of HIV should be told that these methods might or might not increase their risk of HIV. The note also said that women at high risk of HIV who chose Depo or NET-EN should be advised to use condoms as well. Now the WHO has changed Depo and NET-EN rating from MEC 1* to 2.

The MEC ratings are quite important for every woman. The ratings are supposed to be a simple way to help people think about a family planning method. Ideally when a method’s rating changes, the message given to family planning programs and women also needs to change. Since Depo and NET-EN are now graded MEC 2, family planning staff should tell women that these methods might make them more likely to get HIV if they are exposed to it. Most times, people running FP programs do not want to talk about this or simply do not know about this. This news may not matter for some women. These could be women who are not likely to be exposed to HIV or women who are using effective HIV prevention such as condoms or PrEP all the time. But women at high risk of HIV may see it as a reason to use some other methods of contraception and/or HIV prevention.

Making sure that you do not fall pregnant when you are not ready is very important.

So is protecting yourself from HIV. Some women prefer Depo because it lasts for three months. NET-EN lasts for two months. Some use it because they have used it before, their friends use it, or it is the only method on offer at their clinic. Women should ask their service providers to tell them about other methods they have. Once you know what the choices are, you may still choose Depo or NET-EN. Or you may try another method.

Most clinics have oral pills and condoms to give out, as well as Depo. If they do not, women have the right to demand more choices! Women need and deserve a range of family planning methods to choose from.

For women living with HIV, it is important to note that when you are taking two medicines and one has an effect on the other one, we say they “interact”. Most HIV drugs do not interact with family planning drugs. Some might. For example, some family planning implants contain a hormone (called etonogestrel) that interacts with an HIV drug called efavirenz. If you have HIV, talk with your doctor or clinic about your family planning method. It is good to ask if it is one that will interact with your HIV drugs.

With all this science surrounding women and family planning, it is important to note that:

Family planning saves lives. It prevents mis-timed pregnancies which can put women in danger of illness or death. Falling pregnant too many times is not healthy for a woman. It is also risky for a woman or girl to fall pregnant when her body is not ready for it. Each woman should have choices about what she will use for family planning. That way, she can pick a method that keeps her healthy and that she and her partner both like.

Women also need to protect themselves from HIV. Women living with HIV should have access to male and female condoms and to good treatment and care. Women who choose to use Depo or NET-EN may also want to use PrEP. This is a daily pill you can take to keep yourself from getting HIV, if you are exposed to it. Ask your clinic about PrEP if you worry about your HIV risk.

Family planning and HIV prevention are both vital for all women, especially in regions with high HIV rates. To meet these needs, women require access to several kinds of family planning tools and education about how to protect themselves from both mis-timed pregnancy and HIV.

The writer is a communications officer at ICWEA

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