New study questions link between HIV transmission and injectable contraceptives

On Monday, the NY Times reported on a new study which appears to show that the most popular contraceptive for women in eastern and southern Africa may double the risk of HIV infection. In addition, when it is used by HIV-positive women, their male partners are twice as likely to become infected than if the women had used no contraception at all.

These findings, which corroborate research in two other studies, also has limitations. To investigate further, the World Health Organization has decided to convene 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 HIV.

This information is really troubling for a number of reasons.

First, women in Africa face shockingly high rates of maternal mortality, making effective and accessible contraception a key element of a broader public health strategy. In this context, contraceptive access is crucial. Injectable hormones are popular in various parts of Africa. Via the NY Times:

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.

Approximately 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.

The study, published in The Lancet Infectious Diseases, included 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 HIV. Researchers followed most couples for two years, had them report on their contraception methods, and tracked whether the uninfected partner contracted HIV from the infected one.

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.

Depo-Provera has a long and fraught history in the US as well as around the world. This is another reason why this information is particularly troubling. Whether or not this increased risk of HIV transmission is due to Depo-Provera, the generic versions of the drug, or any other factors, I want to scream from the rooftops: We deserve better than this!

Women’s health advocates have long been calling for access to contraceptives that are safe. We have long been calling for adequate testing. Low income women, women of color, and women in the global south, whose fertility is always under attack with population control methods, often bear the burden of unsafe contraceptives. We have long been calling for our right to control our reproduction and to plan our families, and to do so safely and free of coercion.

In a time when right-wing ideologues are fighting so hard to eliminate access to contraception, we have to stand strong for our right to safe and effective birth control. I fear a backlash from those who will try to use this information to deny us access to contraception altogether. But that is not a solution. Denying women the ability to control their lives is not a solution. The only solution is to work even harder to make sure that our safety is valued and protected.

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