For decades, data collected across Africa showed that women who use injectable contraceptives appeared to have a high risk of acquiring HIV compared with those on other birth control methods.
Now a new study commissioned by the World Health Organisation shows that there is no substantial increase in HIV risk among women using three of the most common contraceptive methods on the continent — injectables, implants and the intrauterine devices (IUD).
The results of the randomised clinical trial, known as the Evidence for Contraceptive Options and HIV Outcomes (Echo) was released Thursday in Durban, South Africa.
Conducted among 7,829 women in four African countries — Kenya, Zambia, South Africa and eSwatini — the trial involved sexually active, HIV negative women aged 16-35. It sought to evaluate whether there was any difference in the risk of HIV acquisition among women who used Depo-Provera (injectable) implants (Jadelle) and the IUD.
Participants were randomly assigned to use one of the three contraceptive methods. The study found no higher risk of infection in the use of one method over the other.
According to the results, of the 397 HIV infections that occurred during the study period, 143 were among those using injectables, 138 among those on the IUD while the group using the implant registered 116 infections.
Global HIV/Aids campaigners said the news was reassuring but that a lot still needs to be done to ensure women have access to services to reduce their risk of HIV acquisition while at the same time having access to effective contraceptive services.
“These results contain both good and bad news,” said Mitchell Warren, the executive director of the Global Advocacy for HIV Prevention in a statement.
“On the one hand, a well-run randomised trial has demonstrated no difference in HIV risk among the three highly effective family planning methods, on the other hand the trial is a sobering reminder that women and girls in East and Southern Africa are still at a high risk of HIV infection,” he added.
Dr Placid Mihayo, from the Reproductive Health Division of Uganda’s Health Ministry said the focus should be on educating women on the continued benefits of contraceptive use, while at the same time promoting the use of HIV-prevention tools.
“We have a high fertility rate as a country — 60 per cent of the population is under the age of 30. So we still need to promote family planning as well as programmes that will reduce the risk of HIV acquisition,” he said.
Dr Olive Sentumbwe, the family health and population advisor at the WHO-Uganda office said the focus should be on telling women that consistent and correct use of both the male and female condom will go a long way in protecting them against HIV and other sexually transmitted infections.
According to Dr Rachel Baggaley from WHO’s HIV and Hepatitis department, the results of the study highlight the need to step up HIV prevention efforts in high burden countries, particularly for young women. The East and Southern Africa region continues to have the highest burden of HIV on the continent, according to UNAids.
The WHO Guideline Development Group meets next month to review recommendations concerning women’s eligibility for using different contraceptive methods if they are at high risk of HIV.