Isobel Coleman

Democracy in Development

Coleman maps the intersections between political reform, economic growth, and U.S. policy in the developing world.

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Long-lasting Hormonal Contraception and the HIV Epidemic

by Isobel Coleman
October 4, 2011

A Kenyan woman prepares ribbons ahead of World Aids Day at Beacon of Hope centre, a non-government organization formed to address women's problem of HIV/AIDS in Nairobi in 2004 (Anthony Njuguna/Courtesy Reuters).

A study published online today in the Lancet suggests that hormonal methods of contraception, particularly long-lasting injections, are associated with increased risk of acquiring HIV. Not only were women in the study twice as likely to become infected, but male partners of HIV-positive women were also twice as likely to become infected if the woman was using a long-lasting hormonal contraception as opposed to no contraception.

The study, supported by the National Institutes of Health and the Gates Foundation, adds urgency to a long-simmering debate over whether there is a link between hormonal contraception and HIV. Suspicions date back to the 1990s, but no conclusive work has been done. The Lancet study is also not conclusive due to small sample sizes, and because the study was not specifically designed to examine contraception use. But the doubts raised are sufficient that a full-blown, conclusive study should be launched as soon as possible.

If verified, the findings are serious indeed: women in countries with the highest rates of HIV, mostly in sub-Saharan Africa, are also most likely to choose a long-lasting hormonal shot for birth control. They do so because they can control it (they can receive the shot without anyone, including a partner, knowing about it); the long-lasting nature minimizes travel time, which can be arduous in places with few roads or health clinics; and the shots don’t have to be administered by doctors, who are too often few and far between. As a result, hormonal injections are the most popular form of contraception in Eastern and Southern Africa. Approximately 12 million women in sub-Saharan Africa between the ages of 15 and 49 rely on contraceptive injections. It would be a tragedy if this form of birth control (and other forms of hormonal contraception) were helping to spread the HIV epidemic.

Today, there are well over 200 million women in the world who would like to delay or avoid pregnancy yet do not have access to birth control. Of the 50 highest-fertility countries in the world, nearly 90 percent of them are in sub-Saharan Africa. Meeting demand for family planning can significantly improve maternal, infant, and child health, and avert unintended pregnancies and abortions. If one of the primary forms of contraception today proves to spread HIV, then finding alternatives becomes imperative. I hope the scientific community treats this issue with the urgency it deserves.

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