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Birth Control and HIV+ Women

There are many options available to prevent pregnancy. It is important to get accurate and up-to-date information in order to choose the right one for you.  
Before deciding on a HIV method ask the following questions:
 
Does it interact with my HIV drugs or other drugs I am taking?
Does it provide protection from sexually transmitted diseases (STDs) including HIV? How well will it fit into my lifestyle?
How convenient will it be?
How effective is it?
How safe is it?
How affordable is it?
How will it impact my chances of getting pregnant in the future if I choose to?

Hormone Methods
Hormone-based contraceptives are available in combined estrogen and progesterone (ethinyl estradiol/norethindrone) or progesterone-only formulations. Hormone methods are available in many different forms including "The Pill," "The Shot," implants, vaginal rings, "The Patch," and IUDs.

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Depending on which you choose, you will need to use hormone methods daily, weekly, monthly, or yearly. You need a prescription for hormone methods and in some cases a doctor must administer them on a regular basis.
 
Very effective (97 to 99 percent) in preventing pregnancy
You do not need to do anything right before sex to prevent pregnancy
May reduce risk of ovarian and endometrial cancers, pelvic inflammatory disease, non-cancerous growths of the breasts, ovarian cysts, and osteoporosis (thinning of the bones)
 
Drawbacks:
 
Not effective against STDs (including HIV)
Some hormone-based birth control methods can interact with HIV drugs. Most research on drug interactions has been done on a combined-hormone pill containing ethinyl estradiol and progesterone.
Many possible side effects
May increase risk for blood clots, heart attack, and stroke (especially among smokers age 35 and older)
 
Decreased levels of ethinyl estradiol (or progesterone) can increase the chances of becoming pregnant. If your HIV drugs decrease the levels of your hormone-based birth control method, you should switch to another form of birth control.
 
Decreased levels of HIV drugs can put you at risk for viral rebound and drug resistance. If your hormone-based birth control method decreases the level of your HIV drugs, you should switch to another form of birth control.  

Some HIV drugs increase the levels of hormone-based birth control methods. It is not clear what affect this will have. In all cases, it is important to discuss drug interactions with your doctor before choosing a hormone method.
 


 

Agenerase (amprenavir)
 
Warning: Ethinyl estradiol has been shown to decrease Agenerase concentrations in the blood. There is a risk for viral rebound and drug resistance. Agenerase is not recommended for use with ethinyl estradiol
 
The following HIV drugs may decrease ethinyl estradiol and/or progesterone levels in your blood:
 
Aptivus (tipranavir)
Kaletra (lopinavir/ritonavir)
Norvir (ritonavir)
Prezista (darunavir/ritonavir)
Lexiva(Telzir,fosamprenavir) decreases both ethinyl estradiol and progesterone
Viracept (nelfinavir) decreases both ethinyl estradiol and progesterone
Viramune (nevirapine)
Rifabutin (a preventative treatment for MAC)
Rifampin (a treatment for MAC and TB)
 
If you are taking any of the above-listed drugs, an alternative form of contraception should be used.
 
The following drugs may increase ethinyl estradiol and/or progesterone levels in your blood:
 
Atripla (efavirenz + tenofovir + emtricitabine)
Reyataz (atazanavir, ATZ) increases both ethinyl estradiol and progesterone
Rescriptor (delavirdine)
Sustiva (efavirenz)
Crixivan (indinavir) increases both ethinyl estradiol and progesterone
Diflucan (a treatment for yeast infections)
 
If you are taking any of the above-listed drugs, especially Sustiva, speak to your doctor about whether an alternative form of contraception should be used.

Barrier Methods

Condoms
Benefits:
 
Female and male condoms are the most effective ways to prevent many STDs (including HIV)
Up to 98 percent effective at preventing pregnancy if used correctly
Female condom is the only female-controlled method of birth control that also provides protection from STDs
Inexpensive
Does not require prescription
 
 
Drawbacks:
 
Male condom requires full cooperation of the male partner
May break if not put on correctly
Must be put on immediately before sex
Female Condoms are expensive and not available everywhere

Diaphragms and Cervical Caps
The diaphragm and cervical cap fit over the cervix. Both need to be fitted by a doctor and used with a spermicide cream or jelly.
 
Benefits:
 
Up to 94 percent effective in preventing pregnancy if used correctly
Can be inserted ahead of time, so as not to interrupt sex
There are usually no side effects
Cannot usually be felt by either partner
 
Drawbacks:
 
Does not offer protection against STDs (including HIV)
May be difficult to insert

Spermicides
Spermicides are available in a variety of forms such as foam, jelly, cream and suppository. Spermicides are not very effective when used alone as birth control and offer no protection against STDs (including HIV).
 
Warning: The spermicide Nonoxynol-9 (N-9) can actually increase HIV risk by irritating the skin in the vagina and rectum. It should not be used as a means of preventing HIV transmission.

Other Methods

Permanent Birth Control (Sterilization)
Sterilization is a surgical procedure that can be performed on a woman (tubal sterilization) or a man (vasectomy). It is almost 100 percent effective against pregnancy; however it is not effective against STDs (including HIV).

Natural Birth Control
Includes abstinence, outercourse, withdrawal, and fertility awareness-based methods (Rhythm Method). The effectiveness of natural birth control options at preventing pregnancy ranges from 100 percent (abstinence) to 73 percent (withdrawal method). Except for abstinence, natural methods are not effective for preventing STDs (including HIV).

Emergency Contraception
There are two methods to help prevent pregnancy after unprotected sex: emergency "morning-after" pills and emergency IUD insertion. These methods can be effective in reducing the risk of pregnancy if started shortly after unprotected sex. They offer no protection against STDs (including HIV).

How to Choose
For HIV+ women, drug interactions and the need to reduce the risk of disease transmission can complicate choosing a method of birth control. Work closely with your doctor or a family planning counselor to decide on the contraceptive that is best for you.

 

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