396 Where There Is No Doctor 2011 Green Pages
almost always cause changes in the monthly
bleeding. A woman using these injections may have
light bleeding every day or every once in awhile.
She will probably stop having monthly bleeding by
the end of the first year. These changes are normal.
Combined injections, such as Lunelle or
Cyclofem, contain both estrogen and progestin.
These injections are good for women who want
to have regular monthly bleeding. Women who
are breastfeeding or who have any of the health
problems described on page 288 should not use
combined injections. Combined injections are given
every month, are more expensive than progestin-
only injections, and are harder to find.
Women using either progestin-only or combined
injections sometimes gain weight and get
headaches, but these effects usually go away after
the first few injections. A woman can stop having
family planning injections any time she wants.
But after she stops, it can take a year or more to
become pregnant and for her monthly bleeding to
return to normal. If she stops having injections and
does not want to become pregnant right away, she
must use another method of family planning.
Contraceptive implants
(Common brands: Jadelle, Implanon, Norplant)
Implants work by preventing the woman’s ovaries
from releasing an egg. The hormone also makes
the mucus at the opening of the womb very thick,
which helps stop the sperm from getting inside the
womb. Implants can be used by women who are
breastfeeding, but should not be used by women
who have any of the health problems described
on page 288. Jadelle has 2 tubes and prevents
pregnancy for 5 years. Implanon has 1 tube and
prevents pregnancy for 3 years. Norplant has 6
tubes and prevents pregnancy for 5 to 7 years.
During the first year, implants may cause irregular
bleeding or more days of monthly bleeding. A
woman may stop having monthly bleeding, but
this does not mean that she is pregnant or that
something is wrong. A woman may also gain weight
or have headaches, but these changes usually go
away as her body becomes accustomed to the
hormone.
A woman can choose to have the implants
removed at any time, but she must find a health
worker who knows how to remove them safely. After
removal, the woman can get pregnant right away, so
she will need to use another family planning method
if she does not want to become pregnant.
Medicines for HIV —
Antiretroviral Therapy (ART)
Medicines called antiretrovirals can help people
with HIV live longer and healthier lives. Taken daily
as a combination of at least 3 medicines, this is
called Antiretroviral Therapy, or ART. See p. 398
for how to use these medicines to prevent HIV
spreading to a baby. Also see p. 357 for another
medicine, cotrimoxazole, that can prevent many
infections in people with HIV.
HIV care and ART programs
As soon as you have a positive HIV test, try to
find an HIV care program where health workers can
see you regularly. They can help you start ART and
manage any possible side effects. Getting drugs
from an ART program is more reliable and less
costly than buying them from a private source.
When is ART needed?
People who test positive for HIV and show signs
that they are becoming unable to fight illnesses well
(see p. 400) probably need ART. A blood test called
a CD4 cell count measures how well the body is
able to fight illnesses. If your CD4 count is below
350, even if you feel healthy, talk to your health
worker about starting ART.
Before starting ART, discuss with your health
worker:
Have you ever taken any ART before? This
may affect what medicines you should
take now.
Do you have any illnesses or serious infections
such as pneumonia or TB? They may need
to be treated first. Get tested.
Do you know about the benefits, risks, and
side effects of ART? Try to talk to someone
who is already using ART as well as your
health worker.
Are you able to take medicines every day, at
the correct times? This is necessary for
ART to work.
Will you have the support of a person you trust
or an HIV support group you can turn to for
information and help?
Do not start taking ART on your own. They may
be the wrong medicines for you and can have
serious side effects or cause drug resistance.
Do not share ART with anyone. The medicines
will not work if you take less than the recommended
doses.
Do not buy ART from someone who is not part of
an approved HIV care or ART program.