Twenty-eight years, hundreds of articles and more than half a dozen systematic reviews after the spectre of an association between the use of modern contraception and an increased risk of HIV acquisition was first raised, two systematic reviews1 2 published in this Journal issue may, at last, close the debate. The reviews update the evidence on the association, and include the findings of a randomised controlled trial (RCT), the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial.3 They were conducted to inform an expert meeting convened by the World Health Organization (WHO) to consider whether the updated evidence warranted changing the recommendations regarding the use of hormonal and intrauterine contraceptive methods by women at high risk of HIV.

First published in 1996, the WHO Medical Eligibility Criteria for Contraceptive Use (WHOMEC) guideline applies a four-category scale to indicate medical eligibility for use of all contraceptive methods in the presence of certain physiological or health conditions or risks, including women at high risk of HIV. Concern had first been raised by a Kenyan study reporting that prostitutes who used oral contraceptives were more …