One worry less
A WORRYING ISSUE FOR many women has finally been laid to rest — hormonal contraceptives do not, after all, increase a woman’s risk of contracting HIV.
This is according to a three-year study conducted by Family Health International (FHI) in Uganda, Zimbabwe, and Thailand.
The study, commissioned by National Institute of Child Health and Human Development of the National Institutes of Health (NICHD) in the US, was the largest and most comprehensive inquiry into the link between contraceptives and HIV to date, involving thousands of women in the three countries.
It compared the women’s patterns of contraceptive use to their risk of infection with HIV to establish if there was any relationship between the two. None was found.
Working in conjunction with seven other collaborating institutions, FHI studied the use of the most commonly prescribed forms of hormonal contraception, namely combined oral contraceptives containing estrogen and progestin, and depot-medroxyprogesterone acetate (DMPA), a three-monthly injectable contraceptive containing progestin only.
“There was no statistically significant difference in the risk of HIV acquisition between users of combined oral contraceptives or DMPA and those not using hormonal contraception,” concluded FHI’s Charles Morrison, who led the study.
One study in Kenya had previously established that DMPA, popularly known as Depo Provera, increased the risk of contracting HIV among high-risk women. The Kenyan study, however, did not investigate the implications of contraceptives in low-risk women, who form the bulk of the population.
In all, 6,109 women participated in the FHI study— 2,235 in Uganda; 2,296 in Zimbabwe and 1,578 in Thailand. The women were tested for HIV four to five times a year, for 15 to 24 months to track their status. Among the researchers involved in the study were HIV/Aids experts from Makerere University.
According to the researchers involved in the study, the findings are important to help clarify the matter among many women, given the “feminisation” of the HIV/Aids epidemic and the fact that more than 100 million women around the world use hormonal contraception. More than 20 million women are currently infected with HIV, mostly as a result of heterosexual relations.
“Understanding whether hormonal contraceptive use alters the risk of HIV acquisition among women is a critical public health issue,” the study authors wrote in an issue of the journal Aids published earlier this year.
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NUMEROUS OTHER STUDies had tried to establish whether contraceptives might increase a woman’s risk of becoming infected with HIV, but their results were largely inconclusive due to several factors, including sample selection and sizes, as well as their duration.
The FHI/NICHD study was designed to overcome many of the limitations that made these studies inexhaustive. For example, the study was conducted primarily among women seeking family planning services, who more closely resemble the vast majority of women using hormonal contraception worldwide, as opposed to high-risk women such as sex workers who are not representative.
ALL THE 6,109 WOMEN INvolved in the study were offered their choice of either oral contraceptives or DMPA, as well as condoms. The women were also intensively counselled on how to use these methods and how to reduce their risk of becoming infected with HIV. The researchers also examined the women for sexually transmitted infections, and offered them treatment, if they needed it.
At the end of the study, 213 Ugandan and Zimbabwean women had become infected with HIV, as well as just three Thai women. The large difference was attributed to socio-economic reasons, national prevalence rates, as well as Thailand’s superior anti-HIV strategy, including the distribution of free condoms in brothels, which had pre-empted a full-blown Aids epidemic there.
Despite the high rate of infections in Uganda and Zimbabwe, the researchers were categorical that they did not find any significant relationship between contraceptive use and vulnerability to HIV.
“In summary, this large, multi-site study found no overall increased risk of HIV acquisition associated with hormonal contraceptive use,” the study authors wrote in Aids. “This provides reassurance for women in moderate and high HIV prevalence settings who need effective contraception that any increased overall risk associated with hormonal contraception is, at most, modest.”
According to the researchers, the study however confirmed that other risk factors played a role in the transmission of infection. The risk of contracting HIV during the study was, for example, two times greater for women with genital herpes infection than it was for women without herpes infection, regardless of whether the women used hormonal contraception or not.
Previous studies have found genital herpes, as well as other sexually transmitted diseases, to be major risk factors for acquiring HIV. About half of all women enrolled in the FHI study had genital herpes, thus raising their vulnerability to HIV.
Apart from FHI and Makerere University, the other institutions involved in the study were the University of Zimbabwe; the US universities of California, Case Western Reserve, and Johns Hopkins; and the Chiang Mai University, of Thailand. Family Health International is a non-profit international organisation dealing with reproductive health issues.