Contraception for Women and Couples with HIV. Knowledge Test

Contraception for Women and Couples with HIV Knowledge Test Instructions: For each question below, check/tick all responses that apply. 1. Which statements accurately describe the impact of HIV/AIDS in sub-saharan Africa? a. Almost 57 percent of adults living with HIV are women. b. Almost 60 percent of pregnant women are HIV-infected. c. Three-quarters of all 15- to 24-year-olds living with HIV are female. d. There are more men infected with HIV than women. 2. What cultural and biological factors may cause women to be more vulnerable to HIV infection? a. Gender inequities limit women s opportunities and often make them economically dependent on men. b. Inequitable relations between men and women make it more difficult for women to refuse unwanted sex or to negotiate safer sex. c. The vagina presents a large surface area that is exposed during intercourse to sexual fluids containing HIV. d. Women are genetically predisposed to acquiring HIV. e. Cervical ectopy may increase the risk of chlamydia infection, which may then facilitate the acquisition of HIV infection. 3. Family planning and effective use of contraceptives play an important role in multipronged approaches to prevent HIV by: a. Preventing unintended pregnancies among women who are infected with HIV, thus decreasing the likelihood of transmitting the virus to an infant. b. Decreasing the spread of HIV by killing the HIV virus through exposure to spermicides during sexual intercourse. 4. Women and couples with HIV can achieve the same health benefits from family planning services as others in their communities (e.g., having the number of children they desire and spacing their children to reduce risks). They may also achieve other benefits including: a. Better long-term health outcome in terms of HIV-related illness, since pregnancy speeds up the progression of HIV disease. b. A reduction of HIV infections among children by avoiding unintended pregnancies. c. A reduction in the number of potential orphans when women with HIV use contraception to avoid unintended pregnancy. 5. Which statements accurately describe the unmet need for family planning in sub-saharan Africa? a. In the majority of countries in sub-saharan Africa, more than 20 percent of married women of reproductive age have an unmet need for contraception. b. Local manufacture of contraceptives has significantly reduced the unmet need for family planning by making all modern methods readily available and affordable. c. Evidence of unmet need among young women can be seen in high rates of sexually transmitted infections (STIs), including HIV; unintended pregnancy; and unsafe abortion. August 2005 Contraception for Women and Couples with HIV Knowledge Test 1

6. There are several important research findings that might influence the reproductive decisions of clients with HIV. Which statements are true? a. Pregnancy accelerates HIV disease. b. Pregnancy does not alter the progression of HIV disease. c. ARV therapy can improve the health of persons with HIV. d. Pregnant women with HIV are at increased risk of experiencing stillbirths and delivering low-birth-weight infants. e. At least two-thirds of women with HIV pass the virus to their infants during pregnancy, delivery, and breastfeeding. f. Without treatment, one-third of HIV-infected mothers pass the virus to their newborns during pregnancy, delivery, and breastfeeding. g. There are effective means for reducing mother-to-child transmission of HIV. 7. Which statements accurately describe how antiretroviral (ARV) drugs work? a. The various classes of ARV drugs attack the HIV virus at different stages of replication. b. ARV drugs kill the HIV virus before it can infect cells. c. The standard HAART cocktail combines three drugs from two different classes of antiretrovirals and attacks at least two targets. d. ARV drugs decrease viral load, allowing for improved immune function. 8. ARV drugs are also used for the prophylaxis (prevention) of HIV infection, including: a. Prevention of HIV transmission from mother to child. b. HIV prevention in cases of potential occupational exposure, with single-drug therapy being highly effective. c. HIV prevention in cases of rape where exposure to HIV cannot be ruled out. 9. Women with HIV who are on ARV therapy benefit from using contraception because: a. They can focus more on their ARV therapy and other demands related to HIV disease when their risk of unintended pregnancy is reduced. b. It allows them to avoid a potentially complicated pregnancy (i.e., antiretrovirals can aggravate anaemia and insulin resistance that are common during pregnancy). c. All ARV drugs are contraindicated during pregnancy. d. A wider range of ARV drugs is available to women who are not at risk of pregnancy (some ARV drugs have harmful effects on the foetus and should not be used by women who may become pregnant). 10. Providers of health care services should respect the rights of their clients. All clients seeking family planning services have the right to: a. Access information and services free from any barriers. b. Have a variety of modern contraceptive methods from which to choose. c. Be supported while making an informed, voluntary choice of contraceptive method. d. Receive the contraceptive method of their choice, even though they may not be medically eligible. e. Have a knowledgeable provider who will choose the contraceptive method that he or she considers to be the best choice for the client. August 2005 Contraception for Women and Couples with HIV Knowledge Test 2

11. Providers are the key to ensuring that clients rights are guaranteed. When providing services, effective counsellors: a. Listen carefully and empathize with the client. b. Help clients make their own reproductive health decisions. c. Allow personal preferences and individual experiences to influence the information they present to clients. d. Provide clients with the information required to use their chosen method safely and effectively. 12. In many situations it is appropriate to integrate HIV-related and family planning services to take advantage of programmatic synergies that may be created for clients, providers, and health care facilities. What are some reasons why service integration may be appropriate in certain situations? a. Clients seeking HIV-related services and those seeking family planning services share many common needs and concerns. b. It is always less expensive to provide integrated services. c. A significant, though unknown, proportion of individuals seeking family planning services are at risk of HIV infection or are already infected. d. Clients seeking family planning or HIV-related services are sexually active, are fertile, and may need access to contraceptives and information about how HIV affects their contraceptive options. e. Integrated services may be more attractive to clients. f. The quality of integrated services is always better than separate services. g. Offering more than one service can give providers more opportunities to support drug and method adherence and to follow up on issues raised by clients. 13. Involving men in family planning and other reproductive health programs can have several benefits. When male partners cooperate and participate, the following benefits can be realized: a. Women are better able to act on the HIV prevention messages delivered through reproductive health services. b. Male partners may be more likely to seek HIV counselling and testing and to discuss their HIV status with their partners. c. Women do not need to do anything about HIV/STI prevention because their partners will take care of it. d. Couples are able to make joint informed decisions about their reproductive goals and prevention strategies. e. Client satisfaction is improved and the adoption, continuation, and successful use of a contraceptive method are more likely. 14. The World Health Organization (WHO) has developed medical eligibility criteria for safe use of various contraceptive methods. Which statements are true regarding WHO s criteria: a. Providers use these criteria to decide whether it is appropriate for a woman with a particular medical condition to use the contraceptive method in question. b. Infection with HIV, the presence of AIDS, and use of ARV therapy are some of the medical conditions included in the criteria. c. The WHO eligibility criteria use five categories to classify medical conditions. d. WHO s definition for category 1 is: for women with these conditions, the method presents no risk and can be used without restrictions. e. WHO s definition for category 4 is: for women with these conditions, the method presents a moderate health risk but can still be used with careful supervision. f. In situations where clinical judgment is limited, the classification framework can be simplified into two categories. August 2005 Contraception for Women and Couples with HIV Knowledge Test 3

15. Condoms are one of the contraceptive methods available to women and couples with HIV. Male and female condoms offer the following advantages to clients with HIV: a. Condoms can prevent both pregnancy and STIs when used consistently and correctly. b. In typical use condoms are very effective for preventing pregnancy. c. Condoms can prevent possible superinfection with a different HIV strain. d. In a dual method use approach, condoms are used to protect against HIV/STI transmission, while another method is used for pregnancy prevention. 16. There are several issues and theoretical concerns related to the use of hormonal contraception among women with HIV who are taking ARV drugs. The following statements accurately describe these issues and theoretical concerns: a. Research has proven that combined oral contraceptives do not affect the efficacy of ARV drugs. b. Some ARV drugs can reduce blood levels of contraceptive hormones; lower concentrations could reduce the effectiveness of hormonal contraceptives. c. Some ARV drugs can increase blood levels of contraceptive hormones; higher concentrations could increase hormone-related side effects. d. Evidence from available research on ARVs and hormonal contraception is sufficient to warrant more restrictive changes to existing clinical practices. 17. Preliminary research suggests that hormonal contraceptives have an affect on the risk of acquiring STIs and the cervical shedding of HIV virus. Which of the following diagrams correctly summarizes the initial findings? a. Using hormonal contraceptives may increase: risk of acquiring cervical STIs cervical shedding of HIV virus Cervical STI infections may also increase cervical shedding of HIV More HIV virus may increase risk of partner transmission b. Using hormonal contraceptives may decrease: risk of acquiring cervical STIs cervical shedding of HIV virus Cervical STI infections may also decrease cervical shedding of HIV Less HIV virus may decrease risk of partner transmission August 2005 Contraception for Women and Couples with HIV Knowledge Test 4

18. Some studies have raised concerns that hormonal contraceptives may affect disease progression in women with HIV. Which of the following statements accurately reflect these concerns? a. Use of Depo-Provera (DMPA) at the time of HIV infection was associated with a higher viral load set point, which may hasten the natural course of HIV infection. b. Use of hormonal contraceptives by women with HIV is associated with a higher risk of developing HIV-related infection (opportunistic infection) compared to nonhormonal users with HIV. c. Use of hormonal contraceptives near the time of HIV acquisition is more likely to result in infection with multiple subtypes of HIV. 19. Which statements accurately summarize the WHO eligibility criteria with regard to clients who are HIV-infected, have AIDS, and are on ARV therapy? a. Male condoms are classified as category 1 (no restrictions on use) and female condoms are classified as category 2 (benefits outweigh any theoretical or risks). b. Women with HIV, who may or may not have AIDS, can use oral contraceptives (OCs) without any restrictions (category 1), while OCs can generally be used by women on ARV therapy (category 2). c. Women with HIV, who may or may not have AIDS, can use injectables and implants without any restrictions (category 1), but use of injectables and implants is usually not recommended for women on ARV therapy (category 3). d. An intrauterine device (IUD) can be provided to a woman with HIV if she has no symptoms of AIDS, and she can continue to use the device if she develops AIDS with the IUD already in place (category 2). e. Initiating use of an IUD is generally not recommended in women who already have AIDS (category 3) because of the theoretical risk that advanced immunosuppression could increase the risk of IUD-related complications. f. A woman with AIDS who is doing clinically well on ARV therapy can generally both initiate and continue IUD use (category 2). g. Spermicide and diaphragm use is appropriate for women with HIV/AIDS because both provide effective contraception in typical use and can reduce the risk of HIV superinfection. h. There are no medical reasons to deny sterilization to clients with HIV as long as they are not experiencing any acute AIDS-related illness, in which case the procedure should be delayed. i. Women with HIV who are planning to use the lactational amenorrhoea method (LAM) should be counselled about the risks and benefits of various infant feeding options and the risk of transmitting infection through breast milk. j. Women with HIV, who may or may not have AIDS, can use fertility awareness-based methods without restrictions, while women on ARV therapy should avoid these methods. August 2005 Contraception for Women and Couples with HIV Knowledge Test 5

20. Of the counselling skills listed below, which are considered essential for providers who counsel clients with HIV? a. Demonstrate sensitivity to the circumstances of women and couples with HIV. b. Respect clients rights; explain exceptions to clients rights for clients with HIV. c. Ensure that all women, regardless of HIV status, are free to make informed choice about pregnancy and contraception. d. Be able to counsel about long-term contraceptive methods only, as they provide the best protection from pregnancy. e. Assure privacy and confidentiality. f. Help clients consider how HIV affects individual circumstances and needs. g. Tailor counselling sessions to the needs of the client. h. Facilitate partner involvement and offer partner counselling. i. Provide comprehensive, factual, unbiased information. j. Support the client s family planning decisions; if you disagree, persuade them to do the right thing. 21. What particular issues should providers discuss when counselling women with HIV who are considering pregnancy? a. Pregnancy accelerates HIV disease. b. Risks and rates of mother-to-child transmission. c. ARV drugs administered around the time of delivery reduce HIV transmission to the child. d. Combination of breastfeeding and artificial feeding is best for reducing postpartum HIV transmission. e. Implications of rearing a child with HIV. f. Availability of family support. g. Location and logistics of care and treatment. 22. What particular issues should providers discuss when counselling clients with HIV who are considering contraception, including hormonal contraception while taking ARV drugs? a. Need for couples with HIV to abstain from sexual intercourse. b. Characteristics of contraceptive methods, including possible side effects and complications. c. Ability to use a method correctly (e.g., take pills on schedule, especially if taking ARV drugs). d. Less need to consider method effectiveness due to reduced fertility caused by HIV. e. Implications or drug interactions for women who choose hormonal contraception and are on ARV therapy or are taking rifampicin for coinfection with tuberculosis. f. Limitations of contraceptive methods with regard to prevention of pregnancy and STI/HIV transmission. g. Advantages of dual protection, including dual method use. h. Partner s willingness to use condoms, condom negotiation strategies. i. When to return for questions, problems, method resupply. j. Need to return for frequent follow-up, even when they do not have problems, because of their HIV status. August 2005 Contraception for Women and Couples with HIV Knowledge Test 6

23. In addition to information specific to pregnancy or contraception, what other topics should providers discuss while counselling clients with HIV? a. The importance of knowing a partner s HIV status, including encouraging partner testing if status is unknown. b. Fact that it is not necessary to use condoms if both partners are HIV infected. c. Considerations in disclosing HIV status, including risk of abandonment, violence, or loss of financial support. d. Requirement to bring one s partner for testing as well as to disclose one s own status to the partner. e. Referrals to other reproductive health services as needed, including STI management and treatment; postpartum, postabortion, and antenatal care; and HIV care and treatment. f. Available support systems that may include family, community, social, legal, nutritional, or child health services. 24. To address the contraceptive needs of clients with HIV, programs should: a. Ensure that providers have necessary skills. b. Ensure the availability of family planning commodities and supplies. c. Focus on long-term, more reliable contraceptive methods. d. Provide adequate counselling and storage facilities. e. Offer on-site comprehensive STI/HIV testing and treatment. f. Ensure supervision and management support for family planning services. g. Have a referral system in place for services not provided on site. 25. Contraceptive services can provide an important point of entry into the health care system for clients with HIV. Which statements accurately describe the role that contraceptive services can play in the care of clients with HIV? a. Provide information and methods. b. Assist with preventing HIV transmission. c. Educate clients about harmful effects of pregnancy on HIV disease progression. d. Help clients consider the effect of HIV on family health. e. Assist clients in making informed reproductive health choices. August 2005 Contraception for Women and Couples with HIV Knowledge Test 7

Contraception for Women and Couples with HIV Knowledge Test Answer Key Instructions: For each question below, check/tick all responses that apply. 1. Which statements accurately describe the impact of HIV/AIDS in sub-saharan Africa? <slides 4, 5, 6, 7> a. Almost 57 percent of adults living with HIV are women. b. Almost 60 percent of pregnant women are HIV-infected. <false; one in five = ~20%> c. Three-quarters of all 15- to 24-year-olds living with HIV are female. d. There are more men infected with HIV than women. <false; more women are infected> 2. What cultural and biological factors may cause women to be more vulnerable to HIV infection? <slide 10> a. Gender inequities limit women s opportunities and often make them economically dependent on men. b. Inequitable relations between men and women make it more difficult for women to refuse unwanted sex or to negotiate safer sex. c. The vagina presents a large surface area that is exposed during intercourse to sexual fluids containing HIV. d. Women are genetically predisposed to acquiring HIV. <false; they are not genetically predisposed> e. Cervical ectopy may increase the risk of chlamydia infection, which may then facilitate the acquisition of HIV infection. 3. Family planning and effective use of contraceptives play an important role in multipronged approaches to prevent HIV by: <slide 12> a. Preventing unintended pregnancies among women who are infected with HIV, thus decreasing the likelihood of transmitting the virus to an infant. b. Decreasing the spread of HIV by killing the HIV virus through exposure to spermicides during sexual intercourse. <false; spermicides do not kill HIV virus> 4. Women and couples with HIV can achieve the same health benefits from family planning services as others in their communities (e.g., having the number of children they desire and spacing their children to reduce risks). They may also achieve other benefits including: <slides 14, 18> a. Better long-term health outcome in terms of HIV-related illness, since pregnancy speeds up the progression of HIV disease. <false; pregnancy does not alter the progression of HIV disease> b. A reduction of HIV infections among children by avoiding unintended pregnancies. c. A reduction in the number of potential orphans when women with HIV use contraception to avoid unintended pregnancy. August 2005 Contraception for Women and Couples with HIV Answer Key 1

5. Which statements accurately describe the unmet need for family planning in sub-saharan Africa? <slides 15, 16> a. In the majority of countries in sub-saharan Africa, more than 20 percent of married women of reproductive age have an unmet need for contraception. b. Local manufacture of contraceptives has significantly reduced the unmet need for family planning by making all modern methods readily available and affordable. <false> c. Evidence of unmet need among young women can be seen in high rates of sexually transmitted infections (STIs), including HIV; unintended pregnancy; and unsafe abortion. 6. There are several important research findings that might influence the reproductive decisions of clients with HIV. Which statements are true? <slide 18> a. Pregnancy accelerates HIV disease. <false> b. Pregnancy does not alter the progression of HIV disease. c. ARV therapy can improve the health of persons with HIV. d. Pregnant women with HIV are at increased risk of experiencing stillbirths and delivering low-birth-weight infants. e. At least two-thirds of women with HIV pass the virus to their infants during pregnancy, delivery, and breastfeeding. <false> f. Without treatment, one-third of HIV-infected mothers pass the virus to their newborns during pregnancy, delivery, and breastfeeding. g. There are effective means for reducing mother-to-child transmission of HIV. 7. Which statements accurately describe how antiretroviral (ARV) drugs work? <slide 24> a. The various classes of ARV drugs attack the HIV virus at different stages of replication. b. ARV drugs kill the HIV virus before it can infect cells. <false; drugs do not kill the virus> c. The standard HAART cocktail combines three drugs from two different classes of antiretrovirals and attacks at least two targets. d. ARV drugs decrease viral load, allowing for improved immune function. 8. ARV drugs are also used for the prophylaxis (prevention) of HIV infection, including: <slide 27> a. Prevention of HIV transmission from mother to child. b. HIV prevention in cases of potential occupational exposure, with single-drug therapy being highly effective. <false; recommended in cases of known exposure, multidrug therapy, started immediately is most effective> c. HIV prevention in cases of rape where exposure to HIV cannot be ruled out. 9. Women with HIV who are on ARV therapy benefit from using contraception because: <slide 28> a. They can focus more on their ARV therapy and other demands related to HIV disease when their risk of unintended pregnancy is reduced. b. It allows them to avoid a potentially complicated pregnancy (i.e., antiretrovirals can aggravate anaemia and insulin resistance that are common during pregnancy). c. All ARV drugs are contraindicated during pregnancy. <false> d. A wider range of ARV drugs is available to women who are not at risk of pregnancy (some ARV drugs have harmful effects on the foetus and should not be used by women who may become pregnant). August 2005 Contraception for Women and Couples with HIV Answer Key 2

10. Providers of health care services should respect the rights of their clients. All clients seeking family planning services have the right to: <slide 31> a. Access information and services free from any barriers. b. Have a variety of modern contraceptive methods from which to choose. c. Be supported while making an informed, voluntary choice of contraceptive method. d. Receive the contraceptive method of their choice, even though they may not be medically eligible. <false> e. Have a knowledgeable provider who will choose the contraceptive method that he or she considers to be the best choice for the client. <false> 11. Providers are the key to ensuring that clients rights are guaranteed. When providing services, effective counsellors: <slide 32> a. Listen carefully and empathize with the client. b. Help clients make their own reproductive health decisions. c. Allow personal preferences and individual experiences to influence the information they present to clients. <false> d. Provide clients with the information required to use their chosen method safely and effectively. 12. In many situations it is appropriate to integrate HIV-related and family planning services to take advantage of programmatic synergies that may be created for clients, providers, and health care facilities. What are some reasons why service integration may be appropriate in certain situations? <slides 33, 34> a. Clients seeking HIV-related services and those seeking family planning services share many common needs and concerns. b. It is always less expensive to provide integrated services. <false> c. A significant, though unknown, proportion of individuals seeking family planning services are at risk of HIV infection or are already infected. d. Clients seeking family planning or HIV-related services are sexually active, are fertile, and may need access to contraceptives and information about how HIV affects their contraceptive options. e. Integrated services may be more attractive to clients. f. The quality of integrated services is always better than separate services. <false> g. Offering more than one service can give providers more opportunities to support drug and method adherence and to follow up on issues raised by clients. 13. Involving men in family planning and other reproductive health programs can have several benefits. When male partners cooperate and participate, the following benefits can be realized: <slide 35> a. Women are better able to act on the HIV prevention messages delivered through reproductive health services. b. Male partners may be more likely to seek HIV counselling and testing and to discuss their HIV status with their partners. c. Women do not need to do anything about HIV/STI prevention because their partners will take care of it. <false> d. Couples are able to make joint informed decisions about their reproductive goals and prevention strategies. e. Client satisfaction is improved and the adoption, continuation, and successful use of a contraceptive method are more likely. August 2005 Contraception for Women and Couples with HIV Answer Key 3

14. The World Health Organization (WHO) has developed medical eligibility criteria for safe use of various contraceptive methods. Which statements are true regarding WHO s criteria: <slides 40, 41, 42, 43> a. Providers use these criteria to decide whether it is appropriate for a woman with a particular medical condition to use the contraceptive method in question. b. Infection with HIV, the presence of AIDS, and use of ARV therapy are some of the medical conditions included in the criteria. c. The WHO eligibility criteria use five categories to classify medical conditions. <false; WHO criteria use four categories> d. WHO s definition for category 1 is: for women with these conditions, the method presents no risk and can be used without restrictions. e. WHO s definition for category 4 is: for women with these conditions, the method presents a moderate health risk but can still be used with careful supervision. <false; for women with these conditions, the method presents an unacceptable health risk and should not be used> f. In situations where clinical judgment is limited, the classification framework can be simplified into two categories. 15. Condoms are one of the contraceptive methods available to women and couples with HIV. Male and female condoms offer the following advantages to clients with HIV: <slides 46, 47, 48, 49> a. Condoms can prevent both pregnancy and STIs when used consistently and correctly. b. In typical use condoms are very effective for preventing pregnancy. <false; in typical use, condoms are one of the less effective methods> c. Condoms can prevent possible superinfection with a different HIV strain. d. In a dual method use approach, condoms are used to protect against HIV/STI transmission, while another method is used for pregnancy prevention. 16. There are several issues and theoretical concerns related to the use of hormonal contraception among women with HIV who are taking ARV drugs. The following statements accurately describe these issues and theoretical concerns: <slides 54, 55, 56, 57, 58 > a. Research has proven that combined oral contraceptives do not affect the efficacy of ARV drugs. <false> b. Some ARV drugs can reduce blood levels of contraceptive hormones; lower concentrations could reduce the effectiveness of hormonal contraceptives. c. Some ARV drugs can increase blood levels of contraceptive hormones; higher concentrations could increase hormone-related side effects. d. Evidence from available research on ARVs and hormonal contraception is sufficient to warrant more restrictive changes to existing clinical practices. <false> August 2005 Contraception for Women and Couples with HIV Answer Key 4

17. Preliminary research suggests that hormonal contraceptives have an affect on the risk of acquiring STIs and the cervical shedding of HIV virus. Which of the following diagrams correctly summarizes the initial findings? <slides 59, 60, 61> a. Using hormonal contraceptives may increase: risk of acquiring cervical STIs cervical shedding of HIV virus Cervical STI infections may also increase cervical shedding of HIV More HIV virus may increase risk of partner transmission b. Using hormonal contraceptives may decrease: risk of acquiring cervical STIs cervical shedding of HIV virus Cervical STI infections may also decrease cervical shedding of HIV Less HIV virus may decrease risk of partner transmission 18. Some studies have raised concerns that hormonal contraceptives may affect disease progression in women with HIV. Which of the following statements accurately reflect these concerns? <slide 62> a. Use of Depo-Provera (DMPA) at the time of HIV infection was associated with a higher viral load set point, which may hasten the natural course of HIV infection. b. Use of hormonal contraceptives by women with HIV is associated with a higher risk of developing HIV-related infection (opportunistic infection) compared to nonhormonal users with HIV. <false> c. Use of hormonal contraceptives near the time of HIV acquisition is more likely to result in infection with multiple subtypes of HIV. August 2005 Contraception for Women and Couples with HIV Answer Key 5

19. Which statements accurately summarize the WHO eligibility criteria with regard to clients who are HIV-infected, have AIDS, and are on ARV therapy? <slides 48, 63, 65, 66, 71, 74, 76, 78, 80> a. Male condoms are classified as category 1 (no restrictions on use) and female condoms are classified as category 2 (benefits outweigh any theoretical or risks). <false; female condoms are also category 1> b. Women with HIV, who may or may not have AIDS, can use oral contraceptives (OCs) without any restrictions (category 1), while OCs can generally be used by women on ARV therapy (category 2). c. Women with HIV, who may or may not have AIDS, can use injectables and implants without any restrictions (category 1), but use of injectables and implants is usually not recommended for women on ARV therapy (category 3). <false; ARV therapy is a category 2> d. An intrauterine device (IUD) can be provided to a woman with HIV if she has no symptoms of AIDS, and she can continue to use the device if she develops AIDS with the IUD already in place (category 2). e. Initiating use of an IUD is generally not recommended in women who already have AIDS (category 3) because of the theoretical risk that advanced immunosuppression could increase the risk of IUD-related complications. f. A woman with AIDS who is doing clinically well on ARV therapy can generally both initiate and continue IUD use (category 2). g. Spermicide and diaphragm use is appropriate for women with HIV/AIDS because both provide effective contraception in typical use and can reduce the risk of HIV superinfection. <false> h. There are no medical reasons to deny sterilization to clients with HIV as long as they are not experiencing any acute AIDS-related illness, in which case the procedure should be delayed. i. Women with HIV who are planning to use the lactational amenorrhoea method (LAM) should be counselled about the risks and benefits of various infant feeding options and the risk of transmitting infection through breast milk. j. Women with HIV, who may or may not have AIDS, can use fertility awareness-based methods without restrictions, while women on ARV therapy should avoid these methods. <false; there are no special restrictions for women on ARV therapy > 20. Of the counselling skills listed below, which are considered essential for providers who counsel clients with HIV? <slides 83, 84> a. Demonstrate sensitivity to the circumstances of women and couples with HIV. b. Respect clients rights; explain exceptions to clients rights for clients with HIV. <false> c. Ensure that all women, regardless of HIV status, are free to make informed choice about pregnancy and contraception. d. Be able to counsel about long-term contraceptive methods only, as they provide the best protection from pregnancy. <false> e. Assure privacy and confidentiality. f. Help clients consider how HIV affects individual circumstances and needs. g. Tailor counselling sessions to the needs of the client. h. Facilitate partner involvement and offer partner counselling. i. Provide comprehensive, factual, unbiased information. j. Support the client s family planning decisions; if you disagree, persuade them to do the right thing. <false> August 2005 Contraception for Women and Couples with HIV Answer Key 6

21. What particular issues should providers discuss when counselling women with HIV who are considering pregnancy? <slides 85, 86> a. Pregnancy accelerates HIV disease. <false> b. Risks and rates of mother-to-child transmission. c. ARV drugs administered around the time of delivery reduce HIV transmission to the child. d. Combination of breastfeeding and artificial feeding is best for reducing postpartum HIV transmission. <false> e. Implications of rearing a child with HIV. f. Availability of family support. g. Location and logistics of care and treatment. 22. What particular issues should providers discuss when counselling clients with HIV who are considering contraception, including hormonal contraception while taking ARV drugs? <slides 37, 38, 39, 67, 87, 88, 89> a. Need for couples with HIV to abstain from sexual intercourse. <false> b. Characteristics of contraceptive methods, including possible side effects and complications. c. Ability to use a method correctly (e.g., take pills on schedule, especially if taking ARV drugs). d. Less need to consider method effectiveness due to reduced fertility caused by HIV. <false> e. Implications or drug interactions for women who choose hormonal contraception and are on ARV therapy or are taking rifampicin for coinfection with tuberculosis. f. Limitations of contraceptive methods with regard to prevention of pregnancy and STI/HIV transmission. g. Advantages of dual protection, including dual method use. h. Partner s willingness to use condoms, condom negotiation strategies. i. When to return for questions, problems, method resupply. j. Need to return for frequent follow-up, even when they do not have problems, because of their HIV status. <false> 23. In addition to information specific to pregnancy or contraception, what other topics should providers discuss while counselling clients with HIV? <slides 90, 91> a. The importance of knowing a partner s HIV status, including encouraging partner testing if status is unknown. b. Fact that it is not necessary to use condoms if both partners are HIV infected. <false> c. Considerations in disclosing HIV status, including risk of abandonment, violence, or loss of financial support. d. Requirement to bring one s partner for testing as well as to disclose one s own status to the partner. <false; encouraged but not required> e. Referrals to other reproductive health services as needed, including STI management and treatment; postpartum, postabortion, and antenatal care; and HIV care and treatment. f. Available support systems that may include family, community, social, legal, nutritional, or child health services. August 2005 Contraception for Women and Couples with HIV Answer Key 7

24. To address the contraceptive needs of clients with HIV, programs should: <slide 92> a. Ensure that providers have necessary skills. b. Ensure the availability of family planning commodities and supplies. c. Focus on long-term, more reliable contraceptive methods. <false; all methods should be available to clients with HIV> d. Provide adequate counselling and storage facilities. e. Offer on-site comprehensive STI/HIV testing and treatment. <false; referrals are an acceptable alternative> f. Ensure supervision and management support for family planning services. g. Have a referral system in place for services not provided on site. 25. Contraceptive services can provide an important point of entry into the health care system for clients with HIV. Which statements accurately describe the role that contraceptive services can play in the care of clients with HIV? <slide 93> a. Provide information and methods. b. Assist with preventing HIV transmission. c. Educate clients about harmful effects of pregnancy on HIV disease progression. <false; pregnancy does not alter disease progression> d. Help clients consider the effect of HIV on family health. e. Assist clients in making informed reproductive health choices. August 2005 Contraception for Women and Couples with HIV Answer Key 8