SA's most popular contraceptive injection does not increase HIV risk

The most popular contraceptive injection in SA does not increase the risk of HIV, answering a question that has bothered scientists for decades.

Some studies suggested the injection, commonly known as Depo-Provera, made it up to 40% easier to contract HIV, sparking widespread global concern. 

A three-year randomised control trial called Evidence for Contraceptive Options and HIV Outcomes (Echo) under the leadership of South Africa's Prof Helen Rees, head of the Wits Reproductive Health and HIV Institute (WRHI), has finally offered the answer.

Results were announced at the SA Aids conference on Thursday, with researchers making sure they were released at an African event to honour the participants. 

"For as long as 30 years we had signals there might be an increased risk [of acquiring HIV] from Depo-Provera," Rees said.

She added there is "undoubtedly a sense of relief at these results", because the three-month injection is often one of the only contraception options for women across sub-Saharan Africa. 

Those who took part in the trial were 7,829 African women from SA, Eswatini (Swaziland), Kenya and Zambia aged 16 to 35.

The women were randomly assigned to use one of three contraceptives - copper non-hormonal intrauterine device (IUD), the Depo-Provera injection and a long-acting levonorgestrel implant (Jadelle) placed under their skin for up to three years.

Most participants said they had only one sexual partner, but 397 participants contracted HIV during the trial.

The infection rate was the same for Depo-Provera as the other two contraceptives: almost four infections for every 100 people annually.

The results, said experts, showed HIV infections in eastern and southern African women were unacceptably high.  

During the trial participants were provided condoms, counselling on how to avoid contracting HIV, and treatment for sexually transmitted infections. About 600 women took antiretrovirals as prevention, known as Prep. 

"The study highlights the need to step up HIV prevention efforts in these high-burden countries, particularly for young women," the World Health Organisation's (WHO's) Dr Rachel Baggaley said.

"These should include providing HIV testing and a range of HIV prevention choices within contraceptive service programmes."

From as early as 2012, WHO held meetings of leading experts in Geneva to determine whether to withdraw Depo-Provera contraception.

The WHO was hesitant to pull Depo-Provera as unwanted pregnancies also pose many safety risks and the contraceptive is widely used, discreet, safe and long-acting.

"In southern and east Africa, many women face the double jeopardy of high HIV prevalence and high maternal and infant mortality from unintended pregnancy," said Dr Nelly Mugo, research associate professor at the University of Washington.

"Tens of millions of women in the region rely on DMPA-IM [Depo-Provera], which is often the only modern method of contraception available in local family planning clinics."