Abstract
A recent multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives. Together with a prior cohort study on African women seeking health services, these data are the strongest yet to appear on the HC-HIV risk. This paper will briefly review the Heffron study strengths and relevant biological and epidemiologic evidence; address the futility of further trials; and propose instead an alternative framework for next steps. The weight of the evidence calls for a discontinuation of progestin-dominant methods. We propose here five types of productive activities: (1) scaling injectable hormones down and out of the contraceptive mix; (2) strengthening and introducing public health strategies with proven potential to reduce HIV spread; (3) providing maximal choice to reduce unplanned pregnancy, starting with quality sexuality education through to safe abortion access; (4) expanding provider training, end-user counseling and access to male and female barriers, with a special renewed focus on female condom; (5) initiating a serious research agenda to determine anti-STI/HIV potential of the contraceptive cervical cap. Trusting women to make informed choices is critical to achieve real progress in dual protection.
Highlights
The recent Heffron et al [1] multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives
A recent study from South Africa demonstrated a raised risk of DMPA that only marginally failed to reach statistical significance and suggested that NET-EN, AIDS Research and Treatment the alternative injectable contraceptive used especially by young women in South Africa, might be a risk factor though of lesser magnitude [7]; a second South African study found a significant association of DMPA with chlamydia infection [8]
DMPA, as a long-acting, highly promoted, popular contraceptive for women, has a clear public health advantage that extends beyond reducing unplanned pregnancy rates to the reduction of maternal mortality and vertical transmission of HIV infection
Summary
The recent Heffron et al [1] multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives. A recent study from South Africa demonstrated a raised risk of DMPA that only marginally failed to reach statistical significance and suggested that NET-EN, AIDS Research and Treatment the alternative injectable contraceptive used especially by young women in South Africa, might be a risk factor though of lesser magnitude [7]; a second South African study found a significant association of DMPA with chlamydia infection [8]. This article will cover four issues: first, review the strengths of the Heffron study; second, reexamine and update biological and epidemiologic evidence to support the HC-HIV association; third, address the likely futility of further trials on this association; and propose an alternative framework for steps
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