WUNRN
HIV/AIDS - CONTRACEPTIVE USED IN
AFRICA MAY INCREASE RISK OF HIV
By PAM BELLUCK -
Published: October 3, 2011
The most
popular contraceptive for women in eastern and southern Africa, a hormone shot
given every three months, appears to double the risk the women will become
infected with H.I.V., according to a large study published
Monday. And when it is used by H.I.V.-positive women, their male partners are
twice as likely to become infected than if the women had used no contraception.
The
New York Times
The findings potentially present an
alarming quandary for women in Africa. Hundreds of thousands of them suffer
injuries, bleeding, infections and even death in childbirth from unintended
pregnancies. Finding affordable and convenient contraceptives is a pressing
goal for international health authorities.
But many
countries where pregnancy rates are highest are also ravaged
by H.I.V., the virus that causes AIDS. So the evidence suggesting that the
injectable contraceptive has biological properties that may make women and men
more vulnerable to H.I.V. infection is particularly troubling.
Injectable
hormones are very popular. About 12 million women between the ages of 15 and 49
in sub-Saharan Africa, roughly 6 percent of all women in that age group, use
them. In the United States, it is 1.2 million, or 3 percent of women using
contraception. While the study involved only African women, scientists said
biological effects would probably be the same for all women. But they
emphasized that concern was greatest in Africa because the risk of H.I.V.
transmission from heterosexual sex was so much higher there than elsewhere.
“The best
contraception today is injectable hormonal contraception because you don’t need
a doctor, it’s long-lasting, it enables women to control timing and spacing of
birth without a lot of fuss and travel,” said Isobel Coleman, director of the
women and foreign policy program at the Council on Foreign Relations. “If it is
now proven that these contraceptions are helping spread the AIDS epidemic, we
have a major health crisis on our hands.”
The study,
which several experts said added significant heft to previous research while
still having some limitations, has prompted the World Health Organization to
convene a meeting in January to consider if evidence is now strong enough to
advise women that the method may increase their risk of getting or transmitting
H.I.V.
“We are going
to be re-evaluating W.H.O.’s clinical recommendations on contraceptive use,”
said Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s
department of reproductive health and research. Before the meeting, scientists
will review research concerning hormonal contraceptives and women’s risk of
acquiring H.I.V., transmitting it to men, and the possibility (not examined in
the new study) that hormonal contraceptives accelerate H.I.V.’s severity in
infected women.
“We want to
make sure that we warn when there is a real need to warn, but at the same time
we don’t want to come up with a hasty judgment that would have far-reaching
severe consequences for the sexual and reproductive health of women,” she said.
“This is a very difficult dilemma.”
The study,
led by researchers at the University of Washington and published in The Lancet Infectious
Diseases, involved 3,800 couples in Botswana, Kenya, Rwanda, South
Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the
woman was already infected with H.I.V. Researchers followed most couples for
two years, had them report their contraception methods, and tracked whether the
uninfected partner contracted H.I.V. from the infected partner, said Dr. Jared
Baeten, an author and an epidemiologist and infectious disease specialist.
The research
was presented at an international AIDS conference this summer, but has now
gained traction, scientists said, with publication in a major peer-reviewed
journal.
The
manufacturer of the branded version of the injectable, Depo-Provera, is Pfizer,
which declined to comment on the study, saying officials had not yet read it.
The study’s authors said the injectables used by the African women were
probably generic versions.
The study
found that women using hormonal contraception became infected at a rate of 6.61
per 100 person-years, compared with 3.78 for those not using that method.
Transmission of H.I.V. to men occurred at a rate of 2.61 per 100 person-years
for women using hormonal contraception compared with 1.51 for those who did
not.
While at
least two other rigorous studies have found that injectable contraceptives
increase the risk of women’s acquiring H.I.V., the new research has some
strengths over previous work, said Charles Morrison, senior director of
clinical sciences at FHI 360, a
nonprofit organization whose work includes researching the intersection of
family planning and H.I.V.