Hormonal Contraceptives and HIV: Comparing Methods, Risk of Acquisition
It is estimated that 144 million women worldwide use hormonal contraception, with 41 million users of injectables and 103 million users of oral contraceptive pills. Previous research has suggested an increased risk of HIV is associated with use of progestin-only injectable contraception (possibly only in women at high risk), but methodological issues have been present in many of these studies.
A new meta-analysis in The Lancet Infectious Diseases reviewed 12 published studies on risk of HIV acquisition and hormonal contraceptive use by women in sub-Saharan Africa. Risk of HIV acquisition was not increased in users of combined oral contraception or oral contraceptive pills or norethisterone enanthate vs. those using non-hormonal or no methods. Use of depot medroxyprogesterone acetate was associated with a small but increased risk of HIV acquisition compared with use of non-hormonal or no methods (pooled hazard ratio [HR] 1.40, 95% CI 1.16–1.69).
A World Health Organization (WHO) panel in 2012 found inconclusive evidence on the possible increased risk of HIV acquisition among women using progestin-only injectable contraception and recommended that these women also always use condoms. The study authors recommend that these results be used to further research regional or geographic and subpopulation differences for the development of context-specific contraceptive policies, particularly in countries in sub-Saharan Africa that are considering withdrawing depot medroxyprogesterone acetate from their family planning programs despite the projected substantial increase in unintended births and maternal and infant morbidity and mortality rates.