Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

19 October 2011

Hormonal Contraception and HIV: A New Study Rekindles the Debate

* Original content from our Mapping Pathways blog team

Earlier this month, the Lancet published the results of a study conducted in Africa, which seemed to suggest that hormonal methods of contraception could lead to increased risk of HIV infection. The New York Times published a story on the study soon after, one that many HIV/AIDS experts are calling “alarmist”. There has been a great deal of press coverage on the study since then. As Dr. Adolfus Muyoti from the George Washington University said in a discussion on the IRMA (International Rectal Microbicide Advocates) listserv, “The news is all over Africa.”

The study, supported by the US National Institutes of Health and the Bill & Melinda Gates Foundation, followed 3,790 heterosexual HIV-1-serodiscordant couples across seven African countries. According to the Lancet, the aim of the study was to determine if hormonal contraceptive use had any effect on the risk of HIV acquisition by women as well as the risk of transmission from HIV-infected women to their male partners. As the below diagram used in The New York Times article illustrates, at first glance the results looks fairly disturbing.

However, as Heather Boonstra, Senior Public Policy Associate at the Guttmacher Institute, points out on the IRMA discussion listserv, “The study is less conclusive than at first appears, and leading experts in the field agree that, by itself, it does not warrant changes to current programs on the ground.”

Isobel Coleman from the Council of Foreign Relations echoes similar sentiments, “The study … adds urgency to a long-simmering debate over whether there is a link between hormonal contraception and HIV … no conclusive work has been done. The Lancet study is also not conclusive due to small sample sizes, and because the study was not specifically designed to examine contraception use.”  She does, however, add that, “The doubts raised are sufficient that a full-blown, conclusive study should be launched as soon as possible.”[1] (To read the complete write-up on the Council of Foreign relations website, click here.)

In Sub-Saharan Africa, where more than 60% of HIV infections occur in women, the ramifications of this link, if confirmed, would be huge. A hormonal shot every three months is the most popular contraceptive method in the region – about 12 million women between 15-49 years of age use these injectable hormones. If hormonal contraception suddenly became less acceptable, Africa would have to deal with the problems of affordability and access that surround other contraceptive methods.

Most healthcare professionals and researchers working in the field agree on the importance waiting for the results to be confirmed and not spreading large-scale panic. Says Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s department of reproductive health and research, “We want to make sure that we warn when there is a real need to warn, but at the same time we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women.”[2]

Perhaps it is Dr. Muyoti sums up the issue best and most succinctly: “This has the makings of a problem that will be highly contentious and will not be resolved in the short term.”


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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