This post was originally featured on the International Conference on Family Planning blog.
In October, The Lancet Infectious Diseases published a study by Renee Heffron and colleagues suggesting that HIV-negative women using hormonal contraception (HC) might be at increased risk for HIV infection. The study also suggested that HIV-positive women using HC might be at increased risk of transmitting HIV to an uninfected male sexual partner. These new findings will be a topic of conversation at the 2011 International Conference on Family Planning later this month in Dakar, Senegal.
Chelsea Polis is an epidemiologist at USAID who received her PhD in reproductive health from the Johns Hopkins Bloomberg School of Public Health (JHSPH) in 2009, and holds an associate faculty appointment in the JHSPH Department of Epidemiology. Working with colleagues at CDC and WHO, Polis is leading two systematic reviews of the evidence to address HC and HIV risk. She offered her perspectives in the following emailed Q&A.
Should women reconsider their HC use in light of this study?
No; at this time, women need not reconsider their HC use in light of this study alone. For the time being, USAID and WHO have not recommended any change to current contraceptive guidelines. Careful evaluation of the Heffron study is underway. This study has several strengths, but also has limitations that complicate the ability to draw definitive causal inference between HC and HIV risk. In addition, previous studies have found inconsistent results. The scientific community is intently focused on understanding and incorporating new evidence in a thorough but rapid manner, and is working to establish consensus on interpretation of the new findings.
It remains critical that known risks and benefits of various contraceptive methods are clearly communicated. If it is ultimately determined that HC increases HIV risk, this will need to be communicated. People should also be informed that HC is not intended to protect against HIV or other sexually transmitted infections (STIs), and that dual protection against unintended pregnancy and STIs/HIV may be achieved by using condoms along with a highly effective contraceptive method.
Why is HC use important, particularly in settings of high HIV risk?
HC methods are highly effective at preventing pregnancy, and are among the most commonly used contraceptive methods in sub-Saharan Africa. Unintended pregnancy is associated with multiple adverse outcomes, including maternal and infant mortality. HIV-positive women report high rates of unintended pregnancy, and helping these women access voluntary contraceptive services could contribute to reductions in perinatal HIV. Furthermore, unanswered questions remain with respect to the relationship between pregnancy and risk of HIV acquisition in women and transmission to men. Competing risks must be carefully considered.
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