Popular Contraceptive In Africa Increases HIV Risk

The latest in a series of studies lends support to the possibility that the most popular form of birth control in many African countries — an injectable contraception that lasts for three months — is linked to an increased risk of HIV infection. Women using this type of birth control were twice as likely to become infected and nearly twice as likely to pass the virus to their male partners, compared to women not using hormonal contraception. Health experts are dismayed by the possibility, which, if true, is a setback for both family planning and HIV prevention. The World Health Organization is calling experts together to figure out what to do next.

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New research suggests that the most popular form of contraception in Southern Africa increases women's risk of getting HIV or of passing the virus to a male partner. But as NPR's Richard Knox reports, it will take some time for experts to determine if that risk is real.

RICHARD KNOX, BYLINE: The new study implicates contraceptives that are given by injection every three months. For two decades, research has hinted these contraceptives increase the risk of infection with the AIDS virus, but earlier studies were small or had other design flaws, and the results were mixed.

The new study, which appears in the journal Lancet Infectious Diseases, is larger, nearly 4,000 couples in seven African countries. And study author Jared Baeten says it found a pretty sizable increase in HIV risk among couples who relied on injectable contraceptives.

DR. JARED BAETEN: When I see a two times higher risk, that's a high risk. It's a doubling of the chances that a woman would acquire HIV, or, in the case of an infected woman, that she would pass the virus to her partner.

KNOX: But the study is far from conclusive. Mary Lyn Gaffield of the World Health Organization says the new data are troubling, but the agency doesn't want to overreact.

MARY LYN GAFFIELD: We're trying to be very circumspect. We don't want to jump to hasty conclusions.

KNOX: In January, the WHO is convening experts to look at the new findings and the dozen or so previous studies.

GAFFIELD: If we look at this study in isolation and don't look at the body of evidence, we could be really doing more harm for women's sexual and reproductive health. But at the same time, if there is a risk, we definitely want to act on it.

DR. CHARLES MORRISON: It's a very fine line, I think, that we're walking with this.

KNOX: That's Dr. Charles Morrison. He's with FHI 360, a nonprofit group that manages public health and development projects. Morrison says recent media coverage in Africa, as well as developed countries, goes too far.

MORRISON: The headlines say contraception doubles HIV risk. And that's the worry, that headlines will sort of over-dramatize the results and make them sound more conclusive than they really are.

KNOX: Morrison is just as concerned as anybody in the field. He says it would be tragic if the study turns out to be right, and the most popular contraceptive in Africa is helping to fuel the HIV epidemic.

MORRISON: The opposite side of the coin would also be tragic: to have a rollback in the numbers of women using effective contraception to avoid unintended pregnancy and to avoid all those other bad outcomes that can come with an unintended pregnancy in Africa.

KNOX: In Africa, women often die in childbirth. Infant mortality is high, and HIV is often transmitted from infected mothers to their newborns. And so as Jared Baeten points out, these injectable contraceptives are extremely important.

BAETEN: They are easy to use. They are discreet so that women can choose to use them. They don't require a woman to remember to take a pill every day and, thus, they are very highly effective.

KNOX: But Charles Morrison thinks the only way to resolve this dilemma is to mount a big study. Researchers would randomly assign women to either injectable contraceptives or other kinds and then monitor them for two or three years to see how many HIV infections occur. That would take up to 5,000 women and cost $30 million. The answer wouldn't come for five years. Meanwhile, experts say the best advice for the 12 million African women who are using injectable contraceptives is to get their partners to use condoms, too, every time. Richard Knox, NPR News.

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