Research implications for users and providers.

Extensive research over decades has shown that combined oral contraceptives (COCs) and the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) are extremely safe and pose few serious side effects.

Recent research suggests that use of COCs (1) and DMPA (2) may increase risk of acquiring chlamydial infection.Otherwise, the body of existing research indicates that hormonal contraceptive use does not appear to increase the overall risk of acquiring other sexually transmitted infections (STIs), including HIV and gonorrhea.

However, hormonal contraceptives do not protect against any STIs, including HIV. This means that family planning providers should counsel users of hormonal contraceptives--as well as other methods--to use condoms consistently and correctly with each sexual act if they are not in a mutually monogamous relationship with an uninfected partner. Providers often assume that men and women in married or steady relationships will not use condoms. But an FHI study conducted among 49 Ugandan women--recruited from the recently published study of hormonal contraceptive use and HIV (3)--and their partners found that stable couples in settings with high fertility and high HIV prevalence may be more likely than commonly thought to use condoms. (4)

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Meanwhile, the use of HIV voluntary counseling and testing (VCT) services should be encouraged so more individuals can learn their HIV status. This, in turn, can assist women who do not wish to become pregnant in making contraceptive choices that best meet their needs. For example, some women who learn that they are HIV-positive may strongly wish to prevent pregnancy and thus decide to use a highly effective ...