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The widespread use and success of antiretroviral therapy (ART) has raised the life expectancy and quality of life for HIV-positive women with more getting married and having children.
With access to family planning services, women with human immunodeficiency virus (HIV) can prevent or delay pregnancy using almost any family planning method.
Many women throughout the world use hormonal birth control, which includes birth control pills and injected contraceptives such as Depo-Provera (depot medroxyprogesterone acetate). However, HIV-positive women need to be counseled about the possible increase in HIV risk with hormonal contraceptive use, especially the shot Depo-Provera, and the importance of condom use to decrease risk of HIV. HIV is the virus that causes AIDS.
Hormonal contraceptives – the oral pill and Depo-Provera – increase almost all known risk factors for HIV, from heightening a woman’s risk of infection, increasing the replication of the HIV virus to speeding the debilitating and deadly progression of the disease.
Much more, experts have evidence suggesting that hormonal contraceptives double women’s risk of HIV acquisition and the risk of HIV transmission from women to men. They found that HIV-positive women who used hormonal contraception were twice as likely to transmit the virus to their uninfected partners as women who did not.
In addition, HIV-negative women who used hormonal contraception, either in pill form or injected, were twice as likely to contract HIV from their HIV-positive male partners as women who reported using other forms of birth control or no birth control.
Much more, women using injected contraceptives such as Depo-Provera were found to have higher levels of HIV in the genital tract, even though the levels of HIV in their blood were the same, thus the suggestion that the higher level of HIV in the female genital tract might be a mechanism for increased risk of HIV transmission.
The researchers based on the finding suggested that women should be counseled about potentially increased risk of HIV acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV risk. In addition, they stated that non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV.
The researchers followed nearly 3,800 serodiscordant couples in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe) from 2004 to 2010. Serodiscordant couples are couples in which one partner is HIV-positive and the other partner is HIV-negative.
This was a study published in The Lancet Infectious Diseases. In most of the couples, the partner infected with HIV was the female. In addition, these were couples aged 18 years or older, were sexually active, and were not using antiretroviral therapy.
Around the world, women and girls are at high risk of HIV infection. Over the past 10 years, the proportion of women living with HIV has remained stable. Women account for nearly half of the world’s HIV cases. More than three-fourths of these women live in sub- Saharan Africa, where there are three infected women for every two infected men. The numbers of women with HIV are increasing rapidly in many countries in this region. In Nigeria, for example, prevalence of HIV among women attending public antenatal clinics was put at 4.1 per cent.
But more than 140 million women worldwide use hormonal contraception, including daily oral pills and long-acting injectables, like Depo-Provera, thus the need to rethink the risk factors for sexual risk among young persons, stated Dr Morenike Ukpong, the Coordinator, Nigerian HIV Vaccine & Microbicides Advocacy Group (NHVMAG).
According to Dr Ukpong, “there have been suggestions about the increased HIV infection risk with the use of hormonal contraception. Prior to this study, observational studies have suggested a possible link with observed increased risk of HIV infection with the use of hormonal contraceptives.”
“This study of HIV serodiscordant couples, while not specifically designed to examine this issue, further provides evidence to the possible link between the use of injectable contraceptive and increased HIV risk. The study showed a doubling of the risk of HIV acquisition for HIV-negative women using injectable DMPA (depot-medroxyprogesterone acetate) and a doubling of the risk of HIV transmission from HIV-positive women using DMPA to their seronegative partners.”
No doubt, contraception improves the health of women and children worldwide, and plays a crucial role in helping women with, or at risk of HIV infection to prevent the adverse social and health consequences of unintended pregnancies. However, Dr Ukpong stated that it was important to examine the meaning and implication of these evolving evidences.
“We need to reinforce the importance of correct and consistent condom use, regardless of whether another method of contraception is being used. It is and has been for decades the ‘dual protection’ message,” she said. “It is important for those in the field to be aware of the evolving evidence and its potential implications in the design of HIV prevention services for serodiscordant couples at the least.”
Currently many countries are hoping to lower rate of deaths of mothers from pregnancy and pregnancy related causes by preventing unplanned pregnancies. In addition, UNAIDS has already called for more research and analysis before a January 2012 meeting when the World Health Organisation (WHO) will review various studies as it prepares to revise recommendations on HIV and contraception use, in light of the new findings.
A variety of contraceptive options are currently available to women. However, all of them have both advantages and disadvantages with regard to conception and HIV transmission prevention. But hormonal contraceptives and intrauterine devices should always be combined with regular condom use, since the use of hormonal contraceptives and intrauterine devices alone cannot prevent transmission of HIV or other sexually transmitted diseases.
Previous studies had emphasized women being counseled about the importance of consistent condom use to prevent both sexually transmitted infection (STI) and HIV. In 2004, researchers published in journal AIDS that HIV-infected women using hormonal contraception were more vulnerable to sexually transmitted infections such as Chlamydia infection, and as such the need for them to be counseled about the importance of consistent condom use to prevent both STI and HIV transmission.