Bad news for family planning and H.I.V. prevention

10/5/2011

A troubling front-page article on the cover of the NYTimes yesterday, Contraceptive Used in Africa May Double Risk of H.I.V.

I'm a slightly skeptical of the methodology. Even though there were 3800 couples in the study, only 200 women were using injectable contraceptives (Depo-Provera, or some generic version of it). Of these 200 couples, 10 H.I.V contractions occurred among couples using injectables, while 3 occurred among couples using oral contraceptives. That is a very small sample. Additionally, almost half the women using injectables were also using oral contraceptives over the course of the study and this non-compliance was not accounted for. Although compliance was never the objective, given that this was not a randomized controlled trial.

These are a few points of criticism, but regardless, this study leaves many alarming and urgent questions unanswered. And even if the methodology is skeptical, this article and its spread will itself be detrimental by scarring people away from contraceptives of all forms.

Authors comments on the study.
Full study.

Input credit: AD, DG, BA

3 Comments

10/5/2011 01:36:50 am

I agree with you on the potential backlash of these findings. It took decades to have any meaningful returns on family planning education and implementation and this may put a huge dent to these efforts. Imagine telling a woman in the rural area to use a contraceptive that doubles their risk of contracting the HIV infection. A true clinical study is needed to replicate this observational study and the WHO should slow down on making huge statements about this study before we know for sure what exactly is happening with injectable hormonal contraceptives/ and all hormonal contraceptives for that matter.

10/5/2011 04:25:41 am

From Physician's First Journal Watch:

Women using hormonal contraception — especially injectable forms — show increased risks for acquiring and transmitting HIV infection, according to a Lancet Infectious Diseases study.

Researchers followed some 3800 serodiscordant heterosexual couples in Africa to examine the effect of hormonal contraceptive use on laboratory-confirmed acquisition or transmission of HIV-1. During a median 18 months' follow-up, the multivariable-adjusted HIV acquisition rate in women using hormonal contraception was twice that of women not using it. And similarly, partners of HIV-infected women on hormonal contraception were twice as likely to become infected themselves. Injectable contraception in particular accounted for most of the increased risk.

In his blog HIV and ID Observations, Dr. Paul Sax says part of the explanation "may be the simple fact that women receiving hormonal contraception must be less likely to use condoms. In fact, that ... factor is pretty darn likely, and why the results cannot be considered definitive — even though condom use was controlled for in the study." He advises that condom use be emphasized in counseling women on hormonal contraception.

Aine McCarthy

10/6/2011 04:11:27 am

The url for BH's referenced blog (by Dr Paul Sax):

http://blogs.jwatch.org/hiv-id-observations/index.php/hormonal-contraception-may-increase-risk-of-hiv/2011/10/04/?q=pfw

Bad news for family planning and H.I.V. prevention

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Aine Seitz McCarthy

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