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Injectable contraceptive use found to double HIV risk in Africa
October 4th, 2011
05:22 PM ET

Injectable contraceptive use found to double HIV risk in Africa

Women in Africa who used injectable contraceptives doubled their risk of  becoming HIV-infected and passing the virus on to their male partners, according to a new study published Monday.

"Among couples in which there was an HIV positive man and an HIV negative woman, if she was using hormonal contraceptive, her risk of getting HIV was doubled," said study author Jared Baeten of the University of Washington in Seattle. "Similarly, in couples where there was an HIV infected woman and an HIV negative man, if the woman was using hormonal contraceptives her chances of passing the virus to her partner were doubled."

Almost  3,800 couples with one HIV-infected partner from the African countries of Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe participated in the study. The majority were in their mid-30s and  they were followed for up to two years.The study, published in the Lancet Infectious Diseases, also showed the risk of infection was significantly higher for women who used injectable contraceptives compared with those using birth control pills.  Both injectable and oral contraceptives increased the risk for men, but again only the increase in those using the injectable form was statistically significant.  In fact, the men were twice as likely to become infected with HIV if their female partners used oral contraceptives compared with couples where women used no birth control at all.

"These findings have important implications for family planing and HIV-1 prevention programs, especially in settings with high HIV-1 prevalence," Baeten said. "HIV risk that could be related to contraception is important from a public health point of view. For individual women using hormonal contraception, it's incredibly important that they be counseled that contraception does not protect them from HIV and indeed it increases their risk and thus using condoms along with contraception is critically important to protect against HIV."

Researchers believe this is the first study to show increased risk in male partners from HIV-infected women using hormone contraceptives. They say more studies are needed for other types of birth control containing hormones such as implants and patches and other methods including  intrauterine devices.

"Recommendations regarding contraceptive use, particularly emphasizing the importance of dual protection with condoms and the use of non-hormonal and low-dose hormonal methods for women with or at risk for HIV-1, are urgently needed," said lead author Renee Heffron, University of Washington.

The contraceptive used in the study was depot medroxyprogesterone acetate, one of the most commonly used injectable contraceptives for birth control.  DMPA was approved for contraceptive use in the United States in 1992 and contains progestin only.  The long-acting contraceptive is injected every three months (four times a year), considered nearly 100% effective and has been used by millions of women across the globe, including several million here in the US, according to the National Library of Medicine.

Some of this study's limitations are that the data used was self-reported and specific brands of contraceptives were not recorded.  There also was no data collected on whether the women stuck to the injection schedule. Dr. Charles Morrison, FHI 360, says there have been unanswered questions on the issue for more than two decades.  He says more studies are needed.

"Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic," Morrison said. "Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birth weight babies and orphans–an equally tragic result.  The time to provide a more definitive answer to this critical public health question is now."


soundoff (19 Responses)
  1. etri

    One of the reasons of this double risk is likely that once those women in Africa know they dont risk unwanted pregnancies they go crazy with promiscuity.
    After all, when you have an infected partner, the chances of getting the virus are extremely high no matter what. So I believe the number of partners here also plays a role. And of course those women won't admit it, which may create a bias in the study.

    October 4, 2011 at 18:20 | Report abuse | Reply
    • teresa

      ADULT STEM CELLS CURE'S AIDS / HIV and A NUMBER OF OTHER THINGS BUT WHY????? IS AMERICA BEING HELD BACK FROM THE MAJOR LEAP IN MEDICINE DOES AMERICA WANT TOO KILL YOU ??????? OTHER COUNTRIES MAKING MAJOR LEAPS INTO MEDICINE BUT AMERICA IS STILL IN THE STONE AGE WHY????? WHO BENEFITS THE FDA BIG CORPORATIONS .......?

      October 17, 2011 at 22:53 | Report abuse |
  2. iwearglasses

    umm duuuhhhhhhhhhhhhhhhhhhhhhhhhhhh nooooooooo condommmmmsssss c'mon this is common sense the first thing on there minds give me a break cnn

    October 4, 2011 at 18:31 | Report abuse | Reply
  3. DUH

    This really is a no brainer. Women who don't worry about pregnancy are much more likely to skip using the rubber and then are exposed to their partner's virus. This study is so stupid it's unbelievable. Everyone in Africa should be using condoms every time as well as everyone everywhere for that matter. HIV is 100% preventable (as is unwanted pregnancy). Infected people can still shag but they should do it covered up. How is it that some people still don't know that?

    October 4, 2011 at 19:15 | Report abuse | Reply
    • lon

      i cant agree with u more..this is just a stupid study, waste of resources!

      October 20, 2011 at 18:47 | Report abuse |
  4. THE RISK GENDER FACTOR

    GETTING AN INJECTIBLE BIRTH CONTROL SHOT TO CONTROL UNEXPECTED BIRTHS AND BECOMING MORE SUPCEPTABLE TO HIV IS AN INSULT TO THE HUMAN RACE POPULATION! THERE ARE METHODS AND ALTERNATIVES TO REDUCING THE RISK FACTORS THAT OCCUR WITH THIS METHOD OF BIRTH CONTROL. THE PEOPLE DESERVE THE RESPECT FROM OUR SCIENTISTS WHO DEVELOPE THIS MEDICAL MERRY-GO-ROUND WHICH WE ARE ALL ON. "YOU REAP WHAT YOU SOW!"

    October 4, 2011 at 22:26 | Report abuse | Reply
  5. e

    This is not complicated. Use a condom. If you don't, Than risk getting an STD or HIV. Or were these women in the study only offered birth control and not proper contraceptives to reduce the risk of STD's as well as HIV. If the second is true, than shame on the people conducting this reseach.

    October 4, 2011 at 22:42 | Report abuse | Reply
    • riley

      I am curious too. Was condom usage consistent between the two groups? If not how can they say that hormonal birth control increases incidence of hiv?

      October 4, 2011 at 23:57 | Report abuse |
  6. B

    Sounds so simple, wear a condom. If you ever lived or visited Africa for an extended amount of time, you will quickly learn (like myself) that it's very difficult to apply western thought and values to solve Africa problems. There are many villages in Africa where their culture is very rich in tradition, and have remained intact hundreds, if not thousands of years. Westerner's views are very myopic and ethnocentric.

    October 4, 2011 at 23:39 | Report abuse | Reply
    • intothefire

      Ah yes, cuz the west being ethnocentric has anything to do with this? Nope it doesnt. "it's very difficult to apply western thought and values to solve Africa problems." condom = no aids and no condom = aids. its really that simple, Its only difficult cuz they wont listen. Now the only thing u have right is that their "rich tradition" is the problem, their tradition tells them not to listen. good advice given and not heeded, its not our job to change their minds and let them know they're being idiots

      October 5, 2011 at 00:37 | Report abuse |
  7. Geoffrey Hamilton

    Whoa, wait. Africa has an Aids problem, and we thought we'd fix it with needle based birth control... I'm sorry but this is all new levels of stupid

    October 5, 2011 at 01:04 | Report abuse | Reply
  8. noname

    Pay attention to the article before posting ingenious commentary on condoms and promiscuity: The risk was increased for those using the injection vs an oral contraceptive (NEITHER of which involve a condom); AND the risk was higher in those using a hormonal form of contraception vs no contraception at all. So, what is interesting is that there is SOMETHING about the injectable medication and/or its means of delivery and/or the cultural factors associated with its use that seems to have some risk factor independent of condom use. Moreover, hormonal forms of contraception seem to have some independent risk over no condom at all.
    No one is disputing that condom use is most effective, but this study is about possible variables independent of condom use (i.e. Is there something about the actual medication in the hormonal contraceptives that independently raises the rate of HIV transmission?). Don't you think that would be a useful thing to know? I bet a lot of women who DON'T live in Africa and DO rely on hormonal contraception might think so. This study is not "the answer," but it indicates a question that merits inquiry. So keep the "Duh" comments to yourself.
    (and, No, I was not involved in the study - just an independent commentary)

    October 5, 2011 at 05:43 | Report abuse | Reply
    • Dr.Hollar

      Solid. if you are not used to reading scientific journals its hard to understand what is being reported sometimes. Its a skill that takes time to develop to see clearly what is being stated. Good job explaining for lay persons.

      October 5, 2011 at 14:48 | Report abuse |
  9. Diane W Farr

    genocide

    October 5, 2011 at 07:48 | Report abuse | Reply
  10. Rodeoguy

    Yes, More US federal dollars wasted!

    October 5, 2011 at 12:01 | Report abuse | Reply
  11. Pmac

    Africa is not the only place the injectable birth control and questionable condom usage – I cant even count the number of high school girls having babies that swear they used injectable birthday control AND condoms. I believe more and more education should be required to children beginning in pre-teen years, if not earlier. But honestly, I dont understand the high HIV number – is it excessive population, lack of education, or do african-americans have some genetic issues? I guess that shows, but I'd like an answer that I can understand.

    October 6, 2011 at 09:15 | Report abuse | Reply
  12. BMihaelll

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    October 12, 2011 at 04:56 | Report abuse | Reply
  13. teresa

    ADULT STEM CELLS CURE'S AIDS / HIV and A NUMBER OF OTHER THINGS BUT WHY????? IS AMERICA BEING HELD BACK FROM THE MAJOR LEAP IN MEDICINE DOES AMERICA WANT TOO KILL YOU ??????? OTHER COUNTRIES MAKING MAJOR LEAPS INTO MEDICINE BUT AMERICA IS STILL IN THE STONE AGE WHY????? WHO BENEFITS THE FDA BIG CORPORATIONS .......??

    October 17, 2011 at 22:53 | Report abuse | Reply
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    April 14, 2012 at 13:33 | Report abuse | Reply

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