Hormonal contraception and HIV acquisition - What is the evidence? What are the policy and operational implications?

Objectives: Family planning (FP) is essential in achieving the United Nations Millennium Development Goals. We critically review the evidence on HIV acquisition among women using hormonal contraception, and discuss the policy and operational implications. Methods: Longitudinal studies conducted in sub-Saharan Africa published between 2008 and 2012, as well as key policy documents related to contraception and HIV were reviewed. Results: Findings on hormonal contraception and HIV acquisition conducted in sub- Saharan Africa are inconsistent. While in the large scale studies no statistically significant association between oral contraceptive use and HIV acquisition was found, results for injectables were mixed. Potential biases, such as those resulting from self-selection, related to the observational study design and main confounders such as condom use, sexual activity and contraceptive use are discussed. Conclusions: It is currently not possible to conclude whether the use of hormonal contraceptives is associated with a greater risk of acquiring HIV, or not. The use of male or female condoms for dual protection should be promoted in FP programmes. While there is need for further research on a broader range of contraceptive methods and HIV transmission, studies documenting acceptability of currently less used/more recent contraceptive methods are also warranted.