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Hormonal Contraception and HIV: Weighing the Evidence and Balancing the Risks

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Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

An article in yesterday's New York Times by Pam Belluck suggesting that injectable contraceptive use might double the risk of HIV transmission among women and their partners sent a wave of anxiety through the global public health community. The story is based on a study conducted in Africa by Renee Heffron and her colleagues and published online this week in The Lancet. Heffron's study suggests that HIV-negative women using injectable contraception might face a two-fold risk of acquiring HIV from their infected partners, and that HIV-positive women using injectable contraceptives may be twice as likely to pass the virus on to their uninfected partners.

The Heffron study also found that pregnancy doubled women's risk of HIV infection, underscoring the complex interplay of sexual and reproductive health.

If the findings on injectable contraceptives are confirmed through further research, the implications are profound. Women make up 60 percent of those infected with HIV in sub-Saharan and are highly vulnerable to HIV infection for a range of economic, social, and biological reasons.  Women are simultaneously at high risk of death and disability from complications of pregnancy and unsafe of abortion.  Ending the spread of HIV, filling the unmet need for contraception, and preventing the large number of unintended pregnancies in Africa are critical and highly-intertwined global health goals which, if reached, would save millions of lives and dramatically improve prospects for women and children.

Remove injectable contraceptives from this mix and the picture becomes rather bleak.  “The injectable birth control shot has revolutionized women’s access to modern contraception in developing countries," said Latanya Mapp Frett, Vice President-Global, of Planned Parenthood Federation of America. "This method allows women with infrequent access to health centers to prevent unintended pregnancy, thereby reducing rates of complicated pregnancies, unsafe abortion and maternal death. We need to seriously weigh the evidence before restricting women’s access to this life-saving resource.”

As the Times noted, the World Health Organization (WHO) plans to convene a meeting in January 2012 to review the Heffron study in light of existing evidence and examine the meaning of these findings for delivery of health services.

The possibility that one proven and highly effective health intervention--injectable hormonal contraception--is exacerbating another public health crisis is of course cause for deep concern, and raised reasonable questions among advocates as to why WHO would wait until January to convene a meeting on these issues, and whether distribution of injectable contraceptives should be halted immediately.

Experts say: "Not so fast."

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