Birth control, HIV link

02 March 2012 - 02:37
HIV testing kit. File photo.
Image: SUPPLIED HIV testing kit. File photo.

Women using hormonal birth control, especially progesterone injections, are twice as likely to be infected with, or transmit, HIV, the results of a study published in the Lancet Infectious Diseases journal show.

But a co-author of the study, Professor Helen Rees, of Wits University's Reproductive Health and HIV Institute, said that not all studies show a link between hormonal birth control and increased risk of HIV transmission.

The connection between the use of the hormone progesterone and HIV infection "is a grey area, and the world’s scientists are unsure of how to interpret it” she said. 

“It is an outstanding question and nobody knows how to answer to it.”

The study followed 3790 couples where one partner was HIV positive.

The conclusion of the study was that women must be told "about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods", and about the importance of condoms.

In response, the World Health Organisation held a meeting in Geneva of 75 international experts who decided that the evidence was inconclusive.

In a recent press release, the organisation said "Women at high risk of HIV can safely use hormonal contraceptives".

Former Aids adviser to Unicef, and current co-director of AIDS-Free World Paula Donovan said that the press release was not true because the scientists had agreed that the data were inconclusive.

"The organisation has purposely kept women in the dark about the risk of injectable contraception," Donovan said. “Women have the right to make fully informed sexual and reproductive health decisions."

Rees, who attended the organisation's meeting, said a "room full of experts" agreed that the data were "troubling" and "inconclusive", and more research was needed.

She said doctors did not want to stop women using a contraceptive that worked where women were not easily able to access alternatives and more research might show it to be safe.

But Donovan said that the organisation is violating the rights of the 12million women using the contraceptive injection in sub-Saharan Africa by withholding the information.

"They knew about Depo-Provera (progesterone) users three fold rates of chlamydia and gonorrhoea, two of the sexually transmitted infections that place people at high risk of HIV," she said.

It is believed progesterone thins the vaginal wall, possibly making it more susceptible to infiltration by the HI virus, and suppresses the immune system.

Professor Rees, cautioned that experts don't know what effect of immune suppression has on HIV transmission.

Donovan said that every woman who receives an injection of hormonal contraceptive must also be given a three-month supply of male or female condoms and these should be paid for by the companies that profit from selling the progesterone injection.

The Department of Health's Eddie Mhlanga said its message remained: "Condoms must be used in conjunction with other birth control methods."

Pfizer, in there response to the article said "that it would be premature for non-definitive results to lead to changes in clinical practice.  However, it is very important for physicians to strongly communicate to patients that hormonal contraceptives, including Depo-Provera, are not designed to protect against the transmission of disease.  In this study, up to 30% of women engaged in unprotected sex despite the clear and immediate risk of HIV transmission.  In cases where one partner is known to be HIV-positive, as was the case here, Pfizer believes that consistent and correct use of an effective barrier method must be considered absolutely mandatory."