Contraception and women's HIV risks

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Ugandan and US scientists working in the Rakai District have reported on the relationship between HIV risk and use of different forms of contraception. The Rakai Project Study Group has analysed data including repeated HIV test results from more than 5,000 initially HIV-negative sexually active women aged 15-49, who had access to a range of contraceptive methods. Women were asked detailed questions about their contraceptive use, sexual behaviour and sexual health.

During the study, 202 women became HIV-positive, corresponding to an incidence rate of 1.5% per person year. Of those 202 women, 159 were not using any hormonal contraception or condoms at the time, 12 were using the pill, 16 injectable contraception (mostly Depo-Provera) and 15 were using condoms (inconsistently). These numbers allowed the incidence rates of HIV to be compared between groups of women using the different forms of contraception, although not necessarily between different kinds of oral contraceptive.

Initial comparisons showed a higher incidence of HIV among contraceptive users, although this difference was not statistically significant. After adjusting for numbers of sexual partners, marital status, age, and the presence of genital ulcer disease, it was found that use of hormonal contraceptive pills or injections did not increase or decrease the risk of HIV infection among sexually active women aged 15-49 in this study. Reported ‘inconsistent’ condom use also had no impact on HIV risk (in fact, HIV incidence was relatively high in this group), though among the 350 women who reported ‘consistent’ condom use none became HIV-positive. Women who used oral contraceptives were more likely to report some condom use than women who did not use oral contraceptives.

Glossary

hormone

A chemical messenger which stimulates or suppresses cell and tissue activity. Hormones control most bodily functions, from simple basic needs like hunger to complex systems like reproduction, and even the emotions and mood.

oral

Refers to the mouth, for example a medicine taken by mouth.

ulcer

A break in the skin or mucous membrane which involves the loss of the surface tissue.

 

statistical significance

Statistical tests are used to judge whether the results of a study could be due to chance and would not be confirmed if the study was repeated. If result is probably not due to chance, the results are ‘statistically significant’. 

genital ulcer disease

Any of several diseases that are characterised by genital sores, blisters or lesions. Genital ulcer diseases (including genital herpes, syphilis and chancroid) are usually sexually transmitted.

The last finding points to the significance of this study. Hormonal contraception provides the best protection for many women against unwanted pregnancy and condoms provide the best protection for many women against HIV and other STIs. While this study is not absolutely conclusive, since women who chose different kinds of contraception differed in their sexual behaviour and other risk factors, it is probably the best evidence that will ever be available, to show that hormonal contraceptives do not increase HIV risk.

Among women with HIV who have access to treatment, further issues arise since some ARVs may reduce the effectiveness of hormonal contraceptives. This is discussed in relation to individual drugs on aidsmap.

A NAM factsheet on pregnancy and contraception, written for women with HIV in the UK, is available as a pdf file here and as a web page here.

References

Kiddugavu M et al. Hormonal contraceptive use and HIV-1 infection in a population-based cohort in Rakai, Uganda. AIDS 17:233-240, 2003.