Actions for improved clinical and prevention services and choices preventing HIV and other sexually transmitted infections among women and girls using contraceptive services in contexts with high HIV incidence
According to the recent Evidence for Contraceptive Options and HIV Outcomes Study (ECHO) (Box 1) (1), the incidence of HIV infection and other sexually transmitted infections (STIs) remains high among adolescent girls and women in parts of East and Southern Africa. But, there and elsewhere, contraceptive services offer limited choices for HIV prevention and for contraception. Urgent action is required to invest in and expand HIV prevention, STI services and contraceptive choices in the broader context of providing sexual and reproductive health (SRH) services that uphold the rights of adolescent girls and women.
This programmatic brief explores how to expand HIV and STI prevention and contraceptive method options in contraceptive services and, thus, to reduce HIV and STI incidence among adolescent girls and women. It focuses on settings with extremely high HIV prevalence and incidence. This brief complements existing guidance on HIV prevention and sexual and reproductive health and rights (SRHR), amplifies calls for action and outlines more comprehensive approaches to integration of SRHR and HIV services (2,3). It also emphasizes the importance of SRHR for women living with HIV (4). It aligns with updated WHO recommendations for contraceptive eligibility for women at high risk of HIV (Annex 1, Table A1) (5) and other HIV guidance for adolescent girls and young women.1
This brief is for national programme leaders, experts and members of national working groups on HIV and STI prevention in the context of contraceptive services. It is primarily relevant in settings with very high HIV prevalence in East and Southern Africa, in other high HIV prevalence settings in sub-Saharan Africa and for women from key populations in other regions.2 At the same time, it proposes differentiated strategies for settings with low, medium, high and extremely high HIV prevalence among women.