The Faculty of Sexual and Reproductive Healthcare (FSRH) has changed the UKMEC category for the use of progestogen-only injectable contraception by women at high risk of HIV infection from UKMEC 1 (no restriction to use) to UKMEC 2 (benefits of use generally outweigh the potential risks). The update of the UKMEC guidance follows and aligns with the revised guidance issued by the World Health Organization.
The change in categories are in light of a 2016 systemic review, which reported an association between the use of progestogen-only injectables and the risk of HIV acquisition, but no association was found between the use of other hormonal contraceptive methods and the risk of HIV acquisition. However, these studies do not demonstrate whether progestogen-only injectables cause the increased risk, or whether this is due to confounding factors, such as the non use of condoms.
Women considered to be at high risk of HIV infection can continue to be offered progestogen-only injectable contraception alongside all other suitable contraceptive methods. This group of patients should be made aware of the available evidence so that they can make fully informed contraceptive choices, and should be advised to use effective contraception to reduce the risk of unplanned pregnancy and to use condoms appropriately to minimise the risk of acquiring HIV and other sexually transmitted infections.