Researchers also evaluated the HIV risk associated with birth-control pills. While findings suggest a similar relationship between the pill and HIV risk, study author Jared Baeten of the US University of Washington cautioned that too few women reported using the pill to draw a definite conclusion. Although participants were not asked to identify which injectable birth control they were receiving, it is likely many were on depot medroxprogeterone acetate (DMPA), according to Baeten. More commonly known by its brand name, Depo-Provera, this drug features in most family-planning programmes in Africa. Research from South Africa, with an HIV prevalence rate of about 18%, has indicated it may also be the most prevalent birth control method aside from condoms.
"Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic," said Charles Morrison, senior director for clinical sciences at Family Health International, in a related commentary published in The Lancet. "Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birth-weight babies and orphans - an equally tragic result."
The study is the first to show a relationship between birth control injections and increased HIV risk, Baeten noted. While it did not investigate how, biologically, hormonal contraception increased HIV risk; participants' cervical swabs showed that HIV-positive women on hormonal contraception had increased HIV levels in their genital tracts, which may explain why their male partners were more likely to contract the virus. "Truthfully, we don't know perfectly how HIV establishes itself... what happens between exposure and infection," Baeten told IRIN/PlusNews.
"Previous studies have suggested that perhaps contraception can lead to microscopic thinning of the vaginal mucous membrane [and] changes to genital tract... that makes it easier for HIV to establish itself."
Mucous membranes line body parts like the nose, mouth, vagina and anus. HIV can pass through this type of tissue and into the bloodstream, leading to infection. Damage to this membrane is thought to increase this risk.
Morrison urged donors to support a randomized trial to investigate the link between hormonal contraception and HIV. "The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomized trial of hormonal contraception and HIV acquisition," he wrote. UNAIDS has already called for more research and analysis before a January 2012 meeting when the World Health Organization (WHO) will review various studies as it prepares to revise recommendations on HIV and contraception use.
"If a new study is proposed, it will be years until we have the results so that's why it's important to have correct messaging," said Baeten, adding that women should continue to be offered hormonal contraception but that they should be counselled about the possible risks. The importance of condom use alongside other birth control should be re-enforced. "This study should not result in women stopping contraception - it's too important from the individual and public health perspective," he told IRIN/PlusNews. "It should promote a conversation about how we keep women safe while reducing unplanned pregnancy and the complications from that."
SOURCE: PLUS NEWS
EDIED BY: HERAF STAFF
