By Alex Omari
Media across the globe has been on tabs regarding a recent study that was conducted, suggesting that women who use hormonal contraceptives (injectables), are at an increased risk of becoming infected with HIV and transmitting HIV to partners and others. The big questions that begs is ” is there is enough justifiable evidence available to change our messaging to women about hormonal contraceptives” Hormonal injectables i.e Depo-Provera,Noristat contain only progesterone hormone and are administered once every three and two months respectively.
Study Results The study found that HIV-negative women in Eastern and Southern Africa who used Depo-Provera were two times more likely to become infected with HIV, compared to women who did not use Depo-Provera. The study also found that HIV-positive women who used Depo-Provera were two times more likely to pass HIV on to their partners.
Increased risk of HIV transmission through Hormones Laboratory results suggested that progesterone can cause changes to the vaginal lining, which may increase a woman’s susceptibility to HIV infection. In other words, progesterone can decrease the thickness of the vaginal lining, making it easier for HIV to cross the lining and enter the bloodstream. Research also shows that progesterone can increase the amount of virus (or viral load) in the vaginal fluid of women living with HIV. This may explain why women living with HIV who use hormonal contraceptives appear more likely to transmit HIV to others.
Contradictory Results Although this recent study—and others—suggests that hormonal contraceptives increase the risk of HIV transmission, other studies have found that hormonal contraceptives did not increase the risk of HIV infection. Of those studying Depo-Provera, five studies suggest that it increases the risk of HIV infection among HIV-negative women, while seven others did not. Of the studies looking at birth control pills, only two have suggested that birth control pills increase the risk of HIV infection, while 10 others have not. The recently completed study was the first to suggest that Depo-Provera may increase the risk of an HIV-positive woman transmitting HIV to her partner(s).
Difficult to make any conclusions The conflicting evidence makes it difficult to come to definite conclusions about the relationship between using hormonal contraceptives and an increased risk of becoming infected with HIV and transmitting HIV to others. Further, none of the completed studies were randomized controlled trials (RCTs), which means that it is difficult to know for sure whether or not hormonal contraceptives increased the risk of transmission among women. For example, women using hormonal contraceptives may be more likely to share characteristics that put them at a higher risk of becoming infected with HIV or transmitting HIV, such as having more sexual partners or using fewer condoms. Also, most of the completed studies did not confirm whether women who reported using hormonal contraceptives actually used them.
The verdict The evidence investigating the link between hormonal contraceptives and HIV transmission is inconsistent and limited. Consequently, the question of whether hormonal contraceptives increase the risk of HIV transmission remains unanswered and may require further research. Women using contraceptives to reduce their chances of becoming pregnant may want to consider the use of condoms to reduce the risk of becoming infected with HIV or STIs (or transmitting HIV if they are HIV-positive).
Courtesy of James Wilton
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