A New Approach to Dual Protection Against HIV and Unintended Pregnancy

“Dual method use” for the prevention of both HIV transmission and unintended pregnancy has long meant the simultaneous use of condoms and an effective contraceptive method by couples in which one partner is infected with the virus. But that approach is not without problems. Possible interactions between antiretroviral drugs and hormonal contraceptives may reduce the efficacy of the treatment regimen or the contraceptive one, and reliance on male condoms may impinge on women’s autonomy. An alternative approach to dual method use, however, reduces those risks and may already be working for some couples without their even knowing it. HIV-infected individuals who achieve sustained viral suppression through use of antiretroviral therapy are now thought to have no risk of transmitting the disease through sexual activity; so use of effective contraceptives by people in this situation may provide the dual protection they desire. And in a cohort of sexually active HIV-infected Canadian women studied in 2013–2015, when the protective effect of viral suppression was factored in, the proportion of participants with dual protection was twice the proportion covered by the traditional definition. The authors view this strategy as having enormous potential to engage HIV-infected women in care and improve both HIV-related and other sexual and reproductive health outcomes.

Cover illustrations of Margaret Sanger © Matthew and Eve Levine