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.

Join the Conversation

  • Smiley

    I couldn’t access the article.

    One question: what alternative contraceptive methods were included in the study?

    If the other methods were all barrier methods, then the results are not surprising since only barrier methods are effective against HIV.

    Another question: what were the rates of infection and transmission in those couples who did not use any contraception?

    It would be surprising if their rates were lower. So I am rather surprised at the statement “If it is now proven that these contraceptions are helping spread the AIDS epidemic, [...]”

    Maybe a more accurate statement would be “these contraceptions are not slowing the spread”.

  • Aicha

    I would also be interested to see the information Smiley asked about, although I’m assuming the results showed that couples using BC injections had higher rates of contracting HIV than couples that used non-barrier methods, since we really don’t need a study to show us that those using barrier methods were at lower risk.

    Interestingly, a similar study about how HIV aids is spread and contracted was conducted during the late 90’s & early 2000’s. Initially the results seemed to show that race played a factor in how at risk a person is of contracting HIV. Simply put: if a white person has unprotected sex with an HIV+ person they are LESS likely to contract HIV than a black person. Obviously that would have had huge implications on a number of levels. Fortunately, the study was expanded and the data was further desegregated and it became clear that the determining factor wasn’t race – it was natural resistance to malaria.

    Individuals who have lived in malaria endemic areas for fewer than 5 years (including children born into endemic areas) have no natural resistance to malaria and are completely dependent on malaria prophylactics. Those individuals who have lived in these areas for 5 years or more build up a natural resistance (not immunity) to malaria, similar enough to the resistance provided by the prophylactics that they no longer need to take the drugs.

    Since the majority of participants in the study from non-endemic areas were white, and the majority from endemic areas were black, the data seemed to prove the false conclusion that race was a factor.

    I don’t know if taking malaria prophylactics also increased the likelihood of contracting HIV, but if it did, this new information about BC injections should elicit some studies on how other drugs (even OTC and traditional medicine used in these areas) affect rate of infection.

  • detrick

    It concerns me that there really is no solution to the problem talked about in this article. Do we tell the women to keep using the same method of contraceptives which increases their risks of HIV? Or do we tell them to stop using the injectable hormones that are the best form of birth control for the people of Africa? I do not think there is a simple solution to the problem because it is a matter of which negative has the least effect on the people. I think that the World Health Organization needs to put more effort into researching new types of contraceptives. Also, they could research a way to inject the hormones that would not increase the risk of HIV and AIDS. Research needs to be more concerned with the safety of women before they release a drug into the community. More effort from the world, as a whole, needs to be put into women’s health because it is vital to the stability of families and nations. However, I do not think that all of the problem should be focused on whether or not the vaccine should be given. The World Health Organization needs to focus on educating the younger generation on prevention or nutrition if they already have the disease. Young girls should have a class in school that helps them understand why they need to use protection before they are even faced with the opportunity of sex. Also, young boys should have to understand how contraception works so that they know how to use it and why it is necessary. Parents should be encouraged to talk to their children about protection. There are so many steps to solving this problem and each step is vital to the solving of HIV and AIDS and proper contraception.