Possible contraception link to HIV spread in Africa
By Kevin J. Jones
Dr. Edward Green
Dr. Edward Green

.- Contraceptive use in Africa may increase the risk of acquiring HIV for both men and women, a new study says.

HIV-negative women who use hormonal contraception injections have nearly twice the risk of contracting HIV, while the HIV-negative male partners of infected women also face an increased risk.

The study, led by University of Washington researchers, was published in The Lancet Infections Diseases journal. It involved 3,800 couples in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the woman was already infected.

The study could mean that the promotion of hormonal contraception in Africa has inadvertently fueled the HIV/AIDS pandemic.

The progestin hormone in injectable contraceptives appears to have a physiological effect. Researchers said it could cause immunological changes in a woman’s genitals or could increase the virus’ ability to replicate.

Oral contraceptives also appeared to increase the risk of infection and transmission, but the number of contraceptive pill users was too small to be statistically significant.

There are about 12 million women between ages 15 and 49 in sub-Saharan Africa use injectable contraceptives. The injectable contraceptives used were probably generic versions of Depo-Provera, the researchers said.

Isobel Coleman, director of the women and foreign policy program at the Council on Foreign Relations told the New York Times that if it is proven that contraceptives help spread the AIDS epidemic “we have a major health crisis on our hands.”

Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s department of reproductive health and research, said the organization would be re-evaluating its clinical recommendations on contraceptive use.

“We want to make sure that we warn when there is a real need to warn, but at the same time we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women,” she told the New York Times.

Researchers cautioned that study participants’ contraceptive use was self-reported and the study itself was not designed to examine the contraception issue.

Backers of contraception, in an article accompanying the study, said that curtailing contraception could result in increased maternal mortality and morbidity, more low-weight babies and orphans.

Kenya’s Director of Public Health Shahnaaz Sharif on Oct. 5 said that the contraceptives are “perfectly safe” and cited other studies showing that HIV risk increases with pregnancy and that previous studies have not shown an increased risk among contraceptive users.

Dr. Edward C. Green, president and director of the New Paradigm Research Fund, told CNA Oct. 6 that many experts in the field of family planning do not see this latest study as “the last word on the matter” and there is a “complex debate” around these issues.

“When we are talking about poor, malnourished overworked African women, for example, the evidence shows that the health and even survival of both mothers and their babies is greatly increased if births can be spaced by three or four years, as opposed to a woman having a baby every year until she drops, exhausted or dead, or her babies are born underweight or have other serious problems,” he said.

But, Green cautioned, “there are tradeoffs.”

If hormonal contraceptives cause increased vulnerability to HIV infection, he said, that would “certainly be a big tradeoff for Africans or anyone else where HIV infection rates are high.”

Green, an anthropologist and former director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies, said the New Paradigm Fund grew out of the Harvard project. His organization has “strong views” on AIDS prevention.

“Basically, neither condoms nor drugs are the solution, especially in Africa, where I have done most of my professional work,” he said.

The New Paradigm Fund advocates “behavior prevention strategies” such as changing sexual behavior or reinforcing positive behaviors, instead of advocating more condoms, testing or drugs.

It is a “big mistake” for AIDS funding to go to technology-based prevention strategies and to keep that funding from religious organizations, he added.

Most people become infected through having multiple and concurrent sexual partners and by starting sexual intercourse at an earlier age, he explained.

Religious organizations are “closer to the real solution” in advocating fidelity to one partner at a time and delaying sexual debut than the technology promoted by the United Nations, the United States, the World Bank, the European Union and other global leaders, he said.

Green expands on his criticisms and recommendations about AIDS prevention in his book “Broken Promises: How the AIDS Establishment Has Betrayed the Developing World.”

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