HIV risk did not differ substantially among women using one of three long-acting contraceptive methods, researchers reported in The Lancet. The findings appear to alleviate concerns raised by some earlier studies about a potential association between heightened HIV risk and the use of some hormonal contraceptives. But they also highlight a need for greater communication and education for women in resource-poor regions of the world regarding HIV prevention and family planning.
The researchers randomly assigned 7,829 women seeking contraception in sub-Saharan Africa to receive an injection of depot medroxyprogesterone acetate every three months, a copper intrauterine device, or a levonorgestrel implant. Despite HIV prevention counseling, seroconversion rates were similarly high among the three arms (per 100 woman-years: 4.19, 3.94, and 3.31, respectively). The trial was not powered to detect an increase in seroconversions below 30%, nor did it evaluate all pregnancy prevention methods in use, such as oral contraceptives.
"Our results strongly emphasize the need for more aggressive HIV and STI prevention and management efforts for African women, including PrEP and HIV prevention integrated with contraceptive services," study authors concluded.
In a related commentary, Lisa Miyako Noguchi, Ph.D., of Johns Hopkins University, and Princess Nothemba Simelela, M.D., of the World Health Organization urged, "Decision makers need to listen to the voices of women and girls -- who continue to suffer and die not solely as a result of their unconscionable lack of access to high-quality contraceptive and HIV-related care but also to primary care, cancer prevention, mental health, safe abortion, violence prevention, and maternal health services."