Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

Win-win for both treatment and prevention
March 2016


Many people get their health news from the media, which may relay information that is incorrect or, more often, incomplete. Anyone who checks the news or social media, or any media for that matter, has learned about Charlie Sheen—HIV-infected but with undetectable levels of virus in his serum—and how he had condom-less sex with a couple of partners. However, those reports failed to educate readers and viewers about the risks and protections for HIV transmission.

The National Institutes of Health recently reported on the very low risk of HIV transmission from someone receiving antiretroviral therapy. Good news, undoubtedly—a win-win both for treatment of an infected individual and for prevention of transmission to an uninfected partners. But how should a HIV-uninfected partner be counseled regarding risk if she or he may have a treated partner with undetectable HIV-load?

Beginning in 2005, NIH enrolled 1,763 heterosexual discordant couples in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States, and Zimbabwe. One partner was HIV-infected and the other HIV-uninfected. The HIV-infected partners were randomly assigned to either start antiretroviral therapy (ART) right away (early) or to delay until they developed symptoms. Subjects in both groups were counseled in safer sex practices and to use condoms, which were provided at no cost. Although the randomized control study was stopped in 2011 to offer immediate ART treatment to all HIV-infected persons (because treatment was so effective in preventing transmission),[1] the study was not complete until 2015. In the final analysis, NIH reported that early ART treatment reduced HIV transmission by 93%.[2] [3] Among the HIV-infected study participants who delayed taking ART, 43 of their partners became newly infected. But among the study participants who started ART early, only 8 cases of transmission occurred, with half most likely occurring before treatment had fully suppressed HIV replication. The other cases were thought to occur because the treatment was not taken as prescribed or because a partner’s HIV strain was resistant to the treatment.

Terrific news. ART treatment offers even better protection than does condom use alone with HIV-infected partners. But that is not the entire story, and uninfected partners need to be fully informed. First, undetectable levels of virus do not equate with the absence of virus. The only persons in whom HIV is absent are those who are not infected with the virus to begin with. So what undetectable means is that when the serum is checked, the virus resides at less than 40-75 copies of the virus per ml of blood. It indicates the level of virus load at the time of testing only, not during the time between tests, so it is possible the viral load may increase without the infected person knowing it. ‘Undetectable’ also does not mean that the virus is absent in other body fluids such as semen or vaginal discharges. Further it is thought that co-infection with another STD may boost the HIV load in genital fluids. (See

What an undetectable level does indicate is that the HIV-infected individuals have been taking ART as prescribed, are healthy, and have good immune system response. With fewer copies of HIV in their bodies, they present fewer opportunities to transmit the virus to their uninfected partners. And in regard to the participants in the NIH study of heterosexual discordant couples, the 93% reduction in transmission risk was seen only among those couples in which the HIV-infected partner had been consistently taking ART as prescribed and also maintained a consistently undetectable HIV load.

What would an informed uninfected partner need to know?

  1. Use condoms. Condom use further reduces your risk of HIV, even if your HIV-infected partner is taking ART and has an undetectable viral load.1
  2. Are you, as an uninfected partner, taking or planning to take pre-exposure prophylaxis (PrEP), which also reduces risk, though not to zero. (Mr. Sheen said two women, with whom he had condom-less sex, had opted to take PrEP.[4])
  3. Is your HIV-infected partner taking ART? Consistently and as prescribed?
  4. When was your HIV-infected partner’s last test of viral load?
  5. Does your HIV-infected partner possibly have another STD, too?

For individually tailored information, consult the HIV Risk Reduction Tool developed by the Centers for Disease Control and Prevention:

For another potential win-win scenario, a new randomized study (HPTN 074) has begun enrollment in Indonesia, Ukraine, and Vietnam to test integrated treatment and prevention for people who inject drugs. Index participants have HIV viral loads greater than 1,000 copies/mL at screening, and their partners will be uninfected.

—Deborah Kowal, MA, PA, Executive editor of Contraceptive Technology

—Ward Cates, Jr., Distinguished Scientist and President Emeritus, FHI 360, Durham North Carolina

[1] Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493-505.

[2] National Institute of Allergy and Infectious Diseases. HIV control through treatment durably prevents heterosexual transmission of virus. Press release, July 20, 2015. Accessed Jan 22 2016:

[3] National Institute of Allergy and Infectious Diseases. News & events. Questions and answers. The HPTN 052 study: preventing sexual transmission of HIV with anti-HIV drugs. July 20, 2015. Accessed Jan. 22 2016 at

[4] Kaufman D. Can Charlie Sheen really have doctor-approved unprotected sex? New York Post, Nov. 17, 2015. Accessed Jan. 22 2016 at