A recently published article in the New York Times discusses the correlation between contraceptive use and incidence of HIV infection amongst certain African populations. Depo-Provera, designed by Pfizer, is a hormone injection that contains depo-medroxyprogesterone acetate (DMPA), a synthetic version of the progestin hormone. Injected quarterly, Depo-Provera inhibits pregnancy by one of three mechanisms: inhibiting ovulation, thickening the cervical mucus (which ultimately prevents sperm from swimming to the egg), or by altering the endometrial lining of the uterus to inhibit implantation (American Pregnancy Association). Generic versions of this injection, furthermore, are commonly used as contraceptives by thousands of women residing in southern and eastern Africa. In addition, many other injected hormones are used by approximately 12 million women (ranging from age 15-49) in sub-Saharan Africa, primarily because this method of contraception is simple and long-lasting. However, researchers from the University of Washington published a study that claims that injected hormones, like Depo-Provera, actually increase the risk of H.I.V. infection by twofold. Moreover, H.I.V. positive women who use injected hormones actually double the likelihood of H.I.V. transmission to a male partner. Although the exact mechanism is unknown, researchers postulate that the DMPA induces immunological changes in the vagina and cervix, or even potentially enhance the virus’ ability to replicate itself.
The University of Washington research finding creates a very perilous medical crux for many women, by forcing them to decide between unwanted pregnancy and potential HIV infection/transmission. According to a fact sheet released by the United Nations, the likelihood of a woman dying to pregnancy or childbirth complications in sub-Saharan Africa is 1 in 30, compared to 1 in 5,600 in developed nations. A similarly alarming problem is HIV infection: from the 33.4 million people living with this disease worldwide, two thirds of them reside in sub-Saharan Africa. The University of Washington researchers suggested that a potential solution to this dilemma is increased use of condoms and other forms of contraception like intrauterine devices and implants. In terms of ease, however, hormonal injections trump all of these alternatives.
After the release of the study, members of the World Health Organization have decided to meet and re-consider their decision to internationally support hormonal injections like DMPA. Personally, I feel like the most medically sound route would be to discontinue using the hormonal injections if it increases the incidence of HIV transmission and infection. However, I realize not everyone would agree with me, considering the wide-ranging effects of complicated pregnancies and deliveries for women in sub-Saharan Africa. What do you think?
To read the article published by Pam Belluck in the New York Times, please visit: http://www.nytimes.com/2011/10/04/health/04hiv.html?pagewanted=1&_r=1&ref=health
Sources Cited:
American Pregnancy Association. Accessed 6 Oct. 2011.
United Nations. “Goal 6: Combat HIV/AIDS, Malaria, and Other Disease.” Fact Sheet.
Accessed 8 Oct. 2011.
After reading your post and the New York Times article, I agree with you. I think that women should be warned that hormonal injections can significantly increase the risk of HIV, especially if there are subsequent studies within the next few months or years that confirm this finding. Because two thirds of all of the people with HIV live in sub-Saharan Africa, any potential remedies for this alarming abundance of HIV are of the upmost importance at the present time.
ReplyDeleteEven though the article states that 12 million women are using these hormonal injections in sub-Saharan Africa, this comprises 6 percent of the women in that age group. Maybe in the grand scheme of things, this 6 percent of women could pursue different methods of contraception if they knew about the potential risks regarding HIV.
However, a complicating factor mentioned towards the end of the article is that pregnancy also doubles the risk of contracting HIV. Moreover, if an infected woman is pregnant, the odds are doubled that she will transmit the disease to men. Increased progesterone during pregnancy causes structural changes in the genital tract mucosa and immunological effects, just like you mentioned with the hormonal injection.
This makes me wonder how effective it would be to solely warn sub-Saharan women about the potential risks of hormonal injections. Would this only increase pregnancy rates?
Warnings about the increased risk of HIV during pregnancy are also important. Hence, education appears to be the key preventative factor here. Hopefully further studies will allow us to better understand the precise relationship between contraceptives and HIV.
I think both of you are right, women should be warned about the risks of using the contraceptive and it should not be so widely promoted as it currently is because of its risks. Though we know that death from childbirth is a terrible occurrence and we want to avoid it as much as possible, AIDS is a much worse epidemic and so avoiding spreading it is a much bigger issue. According to the World Health Organization in 2005 approximately 536,000 women died from childbirth worldwide.1 This is a tragedy considering most of these deaths could be avoided with proper medical care, but relative to other deaths, it is still a fairly small number. In Sub-Saharan Africa alone 1.3 million people died from AIDS at the end of 2009.2 So AIDS kills significantly more people a year than does birthing complications, so the spread of AIDS is much more important than stopping the women from getting pregnant in the first place. Therefore women should be warned about the risks of the injections, since AIDS is more likely to kill the women than is complications from childbirth.
ReplyDeleteSources:
1http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/
2http://www.avert.org/worldstats.htm
While agree with both over the above posts that women should be informed about the increased risk of HIV when using contraceptives, as a former sex educator I have to disagree with article saying that DMPA is the most effective and convenient form of birth control (Belluck). On the contrary, DMPA hosts a vast amount of side effects including weight gain, irregular menses, slow return to fertility after discontinuing, and decreased bone mass (Pfizer DMPA fact sheet). Other forms of birth control are far more effective and longer term. The copper IUD “Paragaurd” lasts for 12 years, does not included any hormones, and after insertion is 99.9% effective at preventing pregnancy. While a down side is that it needs to be inserted by a medical provider, if you factor in the cost that an IUD costs 300 dollars for 12 years versus the 90 dollars it costs every 12 weeks for a injection it seems one could argue a case for clinics pushing IUC’s in Africa. It seems to me that if DMPA does indeed increase the risk of HIV transmission women need to be better educated about reliable birth control options. In addition, I am surprised the article does not mention that there should be a major push for women to use condoms as much as possible. Condoms maybe inconvenient and possibly expensive for women in Africa but they are one of the only effective ways to prevent STI transmission aside from abstinence. I agree that women should be informed of the increased risk while using DMPA I however disagree with the author’s claim that it is the most convenient for of contraceptive. I also believe their needs to be a much greater push to educate women on the importance of condom use even if they are using a hormonal method.
ReplyDeleteBelluck, Pam. New York Times Contraceptive Used in Africa May Double Risk of H.I.V
http://www.nytimes.com/2011/10/04/health/04hiv.html?pagewanted=1&_r=1&ref=health