Public health conflicts in contraception and HIV transmission

This article applies a framework for managing ethical challenges in public health practice to the issues of HIV prevention and prevention of unplanned pregnancy in high-risk groups, focusing specifically on the implications of the finding that certain hormonal contraceptives might increase rates of HIV transmission. Given poor utilisation of barrier contraceptive methods for women at risk of HIV, appeal to population-level utility may call into question the wisdom of removing the one practical and highly effective pregnancy prevention system in the region. While reducing HIV transmission risk benefits all, reducing the availability of effective contraception affects women disproportionately. The political feasibility of proposed options may differ from country to country and hormonal contraceptive methods that may be deemed suitable for one country may not acceptable for another. Gender-related power structures pose barriers to family planning in the sub-Saharan Africa region and hormonal contraceptives, which require nothing from the male partner and that have a lower risk of discovery should covert use be necessary, are likely to be superior to the alternative options. Given the poor utilisation of barrier contraceptive methods in high-risk communities, appeal to population-level utility may call into question the wisdom of removing the one practical and highly effective pregnancy prevention system in the region.¹