Can Certain Contraceptives Increase HIV risk?

I can imagine that those who try to remain current with new developments in contraception and HIV risk reduction may cringe at discovering that something else might place them at increased risk of HIV infection. This time, that something else may be a popular form of contraception, injectable hormones. Injectable hormones, such as the well-known Depo-Provera, are one of the easiest, most cost effective contraception alternatives because they are long lasting, easily administered and and gives women more control over the timing of their pregnancies. Unfortunately, they do not protect against HIV or other sexually transmitted infection. Now, a recent study published in Lancet on October 3, 2011, raises concern that their role in HIV infection might be even more problematic. Researchers from the University of Washington followed almost 4,000 couples for two years in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the woman was already infected with HIV.

The study found that women using hormonal contraception became infected at a rate of almost twice as high compared with those not using that method. Transmission of HIV to men also occurred at a rate almost double from women using hormonal contraception than for those who did not. Two other major ones have also demonstrated increased risk of HIV through the use of injectable contraceptives.

It is not entirely clear why this may be happening. The Progestin in injectable contraceptives may have a physiological effect, such as immunologic changes in the vagina and cervix. Moreover, researchers found more HIV in the vaginal fluid of those using hormonal contraception than those who did not. This might help to explain why men might have increased risk of infection from hormonal contraceptive users.

While the results of this study may be quite sobering, especially to those who use injectible hormonal contraceptives, it is just as important that we remember that for most, HIV risk reduction still remains firmly within our control and underscores the importance of not just knowing one's own HIV status, but that of our partners.

Treatment is Prevention Part 1

Some of you may be aware that the annual HIV Prevention conference has been taking place in Atlanta this week. One of the unique aspects of HIV conferences is that they tend to bring together an eclectic mix of people: consumers, researchers, medical providers, non profits and other assorted advocates. As we, as a society, struggle with finding new and creative ways to reduce the transmission of HIV, it was only natural to consider the impact a medical model might have on this challenge. Perhaps one of the most exciting studies within the last several months demonstrates the benefit of immediate, aggressive HIV treatment in reducing transmission.

Historically, HIV prevention targeted those who were negative. Eventually, more emphasis was placed on "Prevention for Postives," which focused primarily on changing the potentially risky behavior of people who are HIV+. However the promising results of a study, known as HPTN 052,that evaluated whether the immediate use of HAART (Highly Active Anti-retroviral therapy) by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners (which would also potentially benefit the HIV-infected individual), demonstrates the increased role of medical treatmet in prevention. The results of the study were truly groundbreaking: there was a 96 percent reduction in risk of HIV transmission to the HIV-uninfected sexual partners.

The results of this study underscores previous efforts to test as many people as possible by making HIV a routine part of medical care as well as aggressive community mobilization by showing that if we can get HIV+ individuals into care and keep them there, it may reduce overall HIV incidence and save lives. Put another way, this study adds another needed weapon to our arsenal as we continue to make progress if our war against this formidable, entrenched enemy: HIV.

HIV at 30

For the two or three of you (lol) who follow my blog, you may have noticed that I haven't blogged in a while. A lot has happened to me over the last several months that I won't get into now. However, I have returned with a renewed sense of purpose and quite a lot to say.

Much has been written about the 30th anniversary of HIV. I plan to write throughout the year on this topic. It is long and complex area and I cannot begin to do it justice in one or two blogs. So hear I go......

My blog today will be more in the form of a rant. It comes on the heels of a recent radio show on which I appeared. During the show, I experienced a sense of déjà vu; that the conversation I was engaged in has happened before. After 30 years, I was answering many of the same questions, the same way:

* Why are the rates so high in the African Americans so high?
* Whay aren't the churches more involved?
* Why do so many African Americans have conspiracy theories?
* Isn't Magic Johnson cured?
* Why is the stigma so great?
* Isn't AIDS a gay disease occurred to me?

After 30 years, with so many ways to access the information, why hasn't it sunken in? Moreover, this 'HIV illiteracy' does not seemed to be impacted by SES (socio-economic status) I have had the same conversations with people ranging from 6th grade reading levels to doctorates.

Certainly the glass isn't completely empty. We have made strides. There is finally a National HIV strategy. Many cities have instituted robust social marketing and testing intitiatives. And, some faith-based institutions have become involved. But, as I have these daily conversations and watch the rates continue to rise, it still seems apparent that it just hasn't sunken in enough. Without our most important asset, knowledge, we still have a long way to go.