AFRICANGLOBE – Women who use injectable contraceptives have an increased risk of becoming infected with HIV, according to a new study.
The study conducted in Uganda and Zimbabwe fuels a controversy that has been raging for more than two decades. However, the findings will help women make more informed choices about birth control.
The scientists say that the hormones in Depo-Provera may cause changes in the vaginal wall, alter bacteria found in the vagina, or influence a woman’s immune response — any of which could increase risk of HIV.
In recent years, researchers have been gathering evidence showing that injectable contraceptives — depot medroxyprogesterone acetate (Depo-Provera or DMPA) — is associated with an increased risk of HIV infection.
The study published in the September 1 issue of mBio, an online open-access journal of the American Society for Microbiology, shows a possible increase in the risk of HIV for women using the birth control jab, compared with other hormonal methods such as the pill.
Jonathan Monda, a medical doctor at Kenyatta Hospital, said the increased risk does not outweigh the contraceptive benefits of Depo-Provera, particularly in the African countries where the studies took place.
“Banning Depo-Provera would leave many women in developing countries without immediate access to alternative contraceptive options, which would by likely to lead to more unintended pregnancies,” said Dr Monda, adding that more women depend on Depo-Provera in Africa than in the West, where women have many more birth control options that are readily available.
In addition, he said, HIV is much more prevalent in Africa, so women’s overall exposure is higher there. It also could be that some of the women who use Depo-Provera may be younger, more sexually active and less likely to use condoms.
“These things also place women at an increased risk of contracting HIV,” he said
Depo-Provera is injected into a woman’s arm. A single shot provides contraception for about three months, according to Planned Parenthood.
About 144 million women around the world use hormonal contraception. About 41 million use injectables such as Depo-Provera and 103 million take the oral contraceptive pill. Women who use the jabs, do so in many cases because it allows them to control their fertility without their husband’s knowledge.
The study conducted by scientists from Harvard Medical School analysed cervical swabs and data from 823 women between the ages of 18 and 35, who were HIV negative and enrolled in family planning clinics in Uganda and Zimbabwe.
Roughly 200 women in this cohort became HIV infected. Women were divided into three groups: Those who used Depo-Provera; those who used oestrogen-progesterone oraBal contraceptives, and those who did not use hormonal contraceptives.
Within each of these groups, the investigators compared results for women with a healthy vaginal environment to women who had a disturbed vaginal microbioata or an infection from bacteria, fungi or parasites.
The team then checked if the women taking oral contraceptives or receiving Depo-Provera were more at risk for immunological changes that can increase a person’s vulnerability to HIV infection than women who weren’t taking a hormonal contraceptive.
They found that Depo-Provera use was associated with an increase in these immunological changes, and that the presence of certain vaginal infections further increased this risk.
In addition, women who had certain vaginal infections or disturbed resident microbiota and took oral contraceptives were also at an increased risk for this unfavourable, immunological profile.
The World Health Organisation advises that women at high risk of HIV should be told that the injectables “may or may not increase their risk of HIV acquisition.”
By: Christabel Ligami
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