Abstract:
The World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March
2017. This guidance followed from a technical consultative meeting convened by the WHO in December 2016, where all the available
evidence on hormonal contraceptives and risk of HIV acquisition was reviewed. This was an expert meeting with representation from
global experts in family planning and HIV management, including clinicians, epidemiologists, researchers and civil society. The guideline
development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from
category 1 to category 2 for progestogen-only injectable contraceptives among women at high risk of HIV. There was no change in the
recommendation for all other methods of hormonal contraception. The data that informed this decision are from observational studies,
which have limitations; therefore, causality or association of hormonal contraception and risk of HIV acquisition have not been proven.
This guidance will have an impact on countries that have a high HIV disease burden and where progestogen-only injectable contraceptives
are the highest used, as in South Africa (SA). The information has to be communicated in line with the WHO’s sexual and reproductive
health rights principles of ensuring that all women should receive evidence-based recommendations. This will empower them to make
informed choices about their reproductive needs. This article seeks to clarify the decision-making process of the WHO and how the new
recommendations were formulated. It also gives SA’s response to the guidance and a perspective of what
