A large scientific analysis in America has shown that contraceptive injections can increase the risk of HIV infection by around 40%.
The study, published in The Lancet medical journal, has gathered data from 12 observational trials which show a 40% increase in the risk of contracting HIV for women using the contraceptive injection –
rather than other hormone based contraception such as the pill or implants.
This is classified as a “moderate increase in risk”, and the impact it will have depends entirely on the woman’s risk of HIV infection in the first place. For those in countries, such as Sub-Saharan Africa the ability to prevent deaths during unwanted pregnancy and birth may outweigh the increased risk of HIV. The implications of this analysis for women who are sex workers, and therefore have a much higher risk of HIV infection, are more alarming.
A number of countries in Sub-Saharan Africa have considered withdrawing use of the contraceptive injections from their family planning clinics. The depot medroxyprogesterone acetate (DMPA), also known by the brand name Depo-Provera, injection has often courted controversy – not least because it allows women to control their own fertility without their husband’s knowledge or permission. The idea that the injection was linked to higher HIV rates was first raised in 1991 but this is the first time research into the theory has been conducted on such a scale.
Epidemiologist and head author of the research Lauren Ralph said the evidence was not strong enough to justify the complete withdrawal of the DMPA jab from the general population:
“Banning DMPA would leave many women without immediate access to alternative, effective contraceptive options. This is likely to lead to more unintended pregnancies, and because childbirth remains life-threatening in many developing countries, could increase overall deaths among women,”
“Further evidence regarding the magnitude and mechanisms of the DMPA and HIV link among high-risk women, such as commercial sex workers and women in serodiscordant partnerships (where one partner is HIV-positive and the other is not), is urgently needed.”
The World Health Organisation advises that women at high risk of HIV should be told that the injectables “may or may not increase their risk of HIV acquisition”, and that couples should be informed and given access to other methods of contraception, including male and female condoms.
An estimated 41 million women currently use the DMPA contraceptive injection.