Contraception to Prevent Mother-to-Child Transmission of HIV

As the HIV/AIDS epidemic continues, programs to prevent mother-to-child transmission (PMTCT) are rapidly rolling out in many developing countries. Most efforts to reduce mother-to-child transmission focus on increasing HIV counseling and testing services and providing antiretroviral drugs such as nevirapine to HIV-infected mothers and their newborns. But another important — and often overlooked — strategy for preventing mother-to-child transmission is to prevent unintended pregnancies in HIV-positive women by increasing contraceptive use.

High demand for contraception already exists in many regions affected by HIV. In Africa, where 60 percent of all new HIV infections occur in women of childbearing age, 25 percent of women do not wish to become pregnant but have no access to contraception. Data from voluntary counseling and testing (VCT) services in four countries show that from 50 percent to 92 percent of women attending VCT clinics do not want another child in the next two years.

Definition

The World Health Organization's PMTCT strategy outlines four approaches necessary for reducing mother-to-child transmission:

1. preventing HIV infection among individuals planning to have children,
2. preventing unintended pregnancies among HIV-infected women,
3. providing HIV counseling and testing to expectant mothers and providing antiretroviral drugs to HIV-infected mothers and their newborns, and
4. supporting HIV-infected mothers and their families, recognizing their continuing needs following HIV diagnosis and childbirth.

Most PMTCT efforts focus on the third approach. But many pregnant women will never be tested for HIV nor know their status at the time of their infant's births and, even when they do, access to antiretroviral drugs is often limited. Adding contraception to the standard PMTCT package has great potential to reduce HIV transmission.

Potential Impact on Aids

Use of contraception is already preventing birth of an estimated 173,000 HIV-infected infants annually in Sub-Saharan Africa. In 2003, contraception averted approximately 22 percent of HIV-positive births in that region of the world, despite the fact that contraception is not widely available in Sub-Saharan Africa. If all women in the region who did not wish to get pregnant accessed contraceptive services, as many as an additional 160,000 HIV-positive births could be averted every year.

Adding contraception to the standard package of PMTCT services would nearly double the number of HIV infections averted. Researchers from U.S.-based Johns Hopkins University and the World Health Organization have also found that a reduction of only 16 percent in unintended pregnancy rates among HIV-infected women (in eight countries studied) would reduce rates of HIV-positive births as much as would current PMTCT efforts.

FHI's Role

Family Health International researchers found that reducing unmet need for contraception was at least as cost-effective for preventing HIV-positive births as the current programmatic emphasis on HIV counseling and testing coupled with nevirapine treatment. When applied to a hypothetical population in Sub-Saharan Africa, FHI's model demonstrated that increasing contraceptive use among sexually active women who wish to avoid pregnancy was approximately 25 percent more cost-effective in averting HIV-positive births than increasing access to PMTCT services (US $663 vs. $857 per HIV-positive birth averted.) These results emphasize the central role that contraception should play in HIV prevention.

Results also showed that the same amount of money invested in increased use of contraceptives averted approximately 30 percent more HIV-positive births than did the traditional PMTCT strategy (30 vs. 23 births). These findings underscore that contraceptive services are as important as traditional PMTCT programs for preventing HIV and therefore deserve more support.