 As an update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC), CDC is revising its recommendations on the use of hormonal contraceptives among women at high risk for HIV, based on new scientific evidence.
Use of the progestin-only injectable contraceptive depot medroxyprogesterone acetate (DMPA) by women at high risk for HIV has been changed from a US MEC Category 1 (no restriction) to Category 2 (benefits outweigh theoretical or proven risks). An accompanying updated clarification states that while there is evidence of a possible increased risk of acquiring HIV among progestin-only injectable users, it is not clear whether this is due to methodological issues with the evidence or a real biological effect.
Women should not be denied the use of DMPA because of concerns about a possible increased risk, but should be counseled about these concerns and about how to reduce their risk of acquiring HIV.
Recommendations for the other hormonal contraceptive methods reviewed (implants, combined hormonal pills, patches, rings, and progestin-only pills) remain the same; there is no restriction for their use among women at high risk for HIV (US MEC Category 1).
All women at risk for HIV infection – regardless of their contraceptive choice – should be counseled about how to reduce their risk of acquiring HIV, including limiting number of sexual partners, correct and consistent condom use, and consideration of pre-exposure and post-exposure prophylaxis.
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Continuing education credit is available for this report.
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