Hormonal contraception and incident HIV-1 infection: new insight and continuing challenges

Abstract

Understanding whether hormonal contraception increases the risk of incident HIV-1 infection among women is a critical public health issue. Hormonal contraception a novelty just four decades ago has become the norm in many countries because of its high efficacy and ease of use. Over 120 million women worldwide use hormonal contraception and its use especially depo-medroxyprogesterone acetate (DMPA) is increasing rapidly in many resource-limited settings. Effective contraception has a key role to play in reducing maternal and infant mortality (by spacing pregnancies) and in allowing women a measure of control over when and how often they become pregnant. At the same time the HIV/AIDS epidemic has reached crisis proportions in a number of sub-Saharan countries and calls for a rapid expansion of both prevention and treatment in resource-limited settings particularly among women of childbearing age. Despite the magnitude of the HIV/AIDS epidemic the level of condom use among married or cohabiting couples in countries classified by UNAIDS as experiencing a generalized HIV epidemic remains very low. Most women who do use contraception rely on oral contraceptives (OC) or injectable DMPA. (excerpt)