Actions to minimize HIV risks.

Actions to Minimize HIV Risks

HIV Status of Couple   For Hormonal           For Family Planning
                       Contraceptive Users    and VCT Providers

Unknown                Seek HIV testing to    Encourage both
                       learn the infection    partners to learn
                       status of both         their HIV status.
                       partners.

                       Practice mutual        Counsel couples on
                       monogamy or, at        benefits of mutual
                       least, reduce number   monogamy. Counsel
                       of sexual partners.    couples who do not
                       Meanwhile, if mutual   practice mutual
                       monogamy cannot be     monogamy to reduce
                       assured, use condoms   number of sexual
                       consistently and       partners and to use
                       correctly to reduce    a condom at each
                       risk of HIV            sexual act. If male
                       infection in           condom use not
                       addition to using      possible, discuss
                       hormonal               option of female
                       contraceptive method   condom use.
                       to reduce risk of
                       unintended
                       pregnancy. If male
                       condom use not
                       possible, consider
                       option of female
                       condom use.

Both HIV-negative,     Remain monogamous to   Counsel couples that
mutually monogamous    ensure protection      mutual monogamy will
                       from sexually          continue to ensure
                       transmitted HIV        protection from
                       infection. Condom      sexually
                       use not necessary      transmitted HIV
                       for prevention of      infection. Condom
                       infection.             use not necessary
                                              for prevention of
                                              infection.

Both HIV-negative,     Practice mutual        Counsel couples on
not mutually           monogamy or, at        benefits of mutual
monogamous, or         least, reduce number   monogamy. Counsel
mutual monogamy        of sexual partners.    couples who do not
uncertain                                     practice mutual
                       Use condoms            monogamy or are not
                       consistently and       sure that their
                       correctly with         relationship is
                       hormonal               mutually monogamous
                       contraceptive method   to reduce number of
                       to reduce risk of      sexual partners and
                       HIV infection and      to use a condom at
                       other sexually         each sexual act. If
                       transmitted            male condom use not
                       infections, as well    possible, discuss
                       as unintended          option of female
                       pregnancy. If male     condom use. Note:
                       condom use not         Even if a couple has
                       possible, consider     tested HIV-negative,
                       female condom use.     one or both
                                              individuals could
                                              become infected
                                              shortly after
                                              testing if the
                                              relationship is not
                                              mutually monogamous.

One or both partners   Use condoms            Emphasize consistent
HIV-positive           consistently and       and correct condom
                       correctly with         use with hormonal
                       hormonal               contraceptive
                       contraceptive method   method to protect
                       to protect             uninfected partners
                       uninfected partners    from HIV infection
                       from HIV infection     (if one partner is
                       (if one partner is     HIV-positive) and to
                       HIV-positive) and      protect against both
                       to protect against     acquisition and
                       both acquisition and   transmission of
                       transmission of        other sexually
                       other sexually         transmitted
                       transmitted            infections and news
                       infections and new     strains of HIV (if
                       strains of HIV (if     both partners are
                       both partners are      HIV-positive).
                       HIV-positive).

                       Consider use of        Counsel couples
                       other highly           about use of other
                       effective, non-        highly effective,
                       hormonal               non-hormonal
                       contraceptives (such   contraceptives (such
                       as the intrauterine    as the intrauterine
                       device or              device or
                       sterilization),        sterilization),
                       especially if the      especially if the
                       woman is HIV-          woman is HIV-
                       infected and           infected and
                       concerned about        concerned about
                       becoming pregnant      becoming pregnant
                       and transmitting       and transmitting HIV
                       HIV to her child;      to her child; the
                       the possible effect    possible effect of
                       of hormonal            hormonal
                       contraceptive use      contraceptive use on
                       on disease             disease progression;
                       progression; or        or interactions
                       interactions between   between hormonal
                       hormonal               contraception and
                       contraception and      antiretroviral
                       antiretroviral         therapy or other
                       therapy or other       drugs used to treat
                       drugs used to treat    AIDS-related
                       AIDS-related           opportunistic
                       opportunistic          infections.*
                       infections.

* Women on antiretroviral therapy generally may use COCs, but
medical follow-up may be appropriate due to unanswered questions
about the effects of antiretroviral- COC interactions. Non-hormonal
methods are recommended for clients taking rifampicin for
tuberculosis.