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'No link between HIV infection and contraceptive methods'

By Carol Natukunda

Added 13th June 2019 05:43 PM

The study found that HIV remains a significant personal risk and public health challenge for many women in these countries.

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The study found that HIV remains a significant personal risk and public health challenge for many women in these countries.

A health worker carries out an HIV test. File Photo
Here is the thing: Except for condoms, no contraceptive method protects a woman against HIV or other sexually transmitted infections.
Yet, many women prefer three methods, namely: Depo-Provera (injectable), the implant and the intrauterine device (IUD). They are discreet and effective.
Against this background, there are concerns that this could put a woman who is using these methods of contraception at risk of contracting HIV. Would she care to protect herself from HIV, given that she is not worried about unwanted pregnancy?
A new study dispels these fears. It has found no link between contraception and HIV infection.
The large clinical research study conducted in four African countries found no significant difference in the risk of HIV infection among women using one of three highly effective, reversible contraceptive methods.
The study, titled Evidence for Contraceptive Options and HIV Outcomes (ECHO) started in 2015. It recruited about 7,829 sexually active HIV-negative women aged 16 to 35 at study sites in Kenya, South Africa, Swaziland, and Zambia.
Participants were randomly assigned to use each of the three contraceptive methods: Depo-Provera (injectable), the implant and the intrauterine device(IUD).
The women who participated in the study received health services, including counseling on HIV prevention and care, screening and treatment for sexually transmitted infections.
According to the results published the Lancet, each of these methods had high levels of safety and effectiveness in preventing pregnancy.
Among the 7829 women who took part in the study, only  397 HIV infections occurred. 143 infections were in women who used DMPA-IM, 138 were in women who used a copper-bearing IUD and 116 in women who used the implant.
The study found that HIV remains a significant personal risk and public health challenge for many women in these countries. This was attributed to the high incidence of HIV infections among all of the women – at an average of 3.8% per year.
“The rate of HIV infection was higher for women under 25 years irrespective of the method of contraception used. This high rate of HIV infection among women, and especially younger women, reinforces the need to strengthen HIV prevention integration within contraceptive and other sexual and reproductive health services,” the study says.
It calls for HIV testing and linkage to antiretroviral therapy for those testing HIV-positive, partner testing, condom promotion, and pre-exposure prophylaxis (PrEP).
“The study highlights the need to step up HIV prevention efforts in these high-burden countries - particularly for young women, including providing HIV testing and a range of HIV prevention choices within contraceptive service programmes,” said Dr. Rachel Baggaley, from the HIV and Hepatitis Department at World Health Organisation(WHO).
“These results support making available to women and girls a broad choice of effective contraceptive methods that empower them to make informed decisions about their own bodies - including if and when to have children. Better access to contraception and quality reproductive health services would have a dramatic impact in bettering the lives of millions of women and their families,” said Dr. James Kiarie, from WHO Department of Reproductive Health and Research.
Currently, 214 million women in developing countries want to avoid pregnancy but do not use a modern contraceptive method. In Uganda, the unmet need for family planning was found at about 30% in May 2017, according to the Performance Monitoring and Accountability report. This is a slight increase compared to the 28% rate indicated in the country’s demographic health survey in 2016.
Experts say increased contraception uptake would avert abortions, maternal and child deaths arising out of unintended or unwanted pregnancies.
Following the research findings WHO announced that it would convene a Guideline Development Group to review its existing recommendations concerning women’s eligibility for using various contraceptive methods if they are at high risk of HIV. Updated recommendations will be issued by the end of August 2019.
The ECHO study was carried out by a consortium led by FHI 360, University of Washington, Wits Reproductive Health and HIV Institute, and the Human Reproduction Programme (HRP) at the World Health Organization.

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