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.