A Safe Birth Control Option for People Living with HIV


Between pills, patches, implants, rings, condoms, and more, choosing a form of birth control is tricky. For people assigned female at birth (AFAB) who are living with HIV, the choice is even harder. The risk of passing the infection to an infant or partner and possible drug interactions with the antiretroviral therapies used to treat HIV add another layer of considerations.

A new study gives evidence that the levonorgestrel intrauterine system (LNG-IUS), also known as a hormonal IUD, is a safe option for those living with HIV. Professor Heidi Jones of the Graduate School of Public Health and Health Policy was an author on the study, published in PLOS Medicine.

AFAB people living with HIV already use birth control at a lower rate than those without the infection, the authors say, and the complex situation makes it hard to counsel people on their options.

“There have been some indications that hormonal methods may affect genital shedding of HIV,” Jones said. In other words, there is concern that hormonal contraceptives could increase the risk of passing the infection to a partner. Previous studies have shown that the non-hormonal copper intrauterine device (C-IUD) is a good option for people with HIV, but little research has focused on the LNG-IUS.

“We wanted to be sure the LNG-IUS was just as safe,” Jones said.

In a two-year trial of 199 volunteers aged 18 to 24 in Cape Town, South Africa, the researchers measured genital viral load, a metric of potential HIV transmission. Some of the volunteers were using antiretroviral therapies and some weren’t, and within each group, some used a C-IUD and others the LNG-IUS. The researchers saw no significant difference in genital viral load between those using the two devices.

“We also found the discontinuation rates to be much lower for the LNG-IUS than for the copper IUD,” Jones said, “suggesting that many might like it better.” The results give those living with HIV another option, and add to HIV education and international guidelines.