New study finds no link between HIV infection and contraceptive use

15Jun 2019
Kenneth Simbaya
The Guardian
New study finds no link between HIV infection and contraceptive use

AFTER decades of uncertainty over increased risks of HIV infection among women using Depomedroxyprogesterone acetate (DMPA)—an injectable contraceptive method, a clinical study shows that there is no link between HIV infection and use of contraceptives.

The study known as Evidence for Contraceptive Options and HIV Outcomes (ECHO), which its finding was released yesterday in South Africa, and monitored by The Guardian through a webinar, found that there is no significant difference in risk of HIV infection among women using one of the three highly effective reversible contraceptive methods, DMPA ( intramuscular -DMPA-IM), a three monthly, progestogen-only, reversible injectable contraceptive; Levonorgestrel implant, a progestogen-only implant inserted under the skin in the upper arm that can be used for up to five years and  A copper-bearing IUD, a device inserted into the uterus that can be used for up to 10-12 years.

While the claim was on DMPA contraceptive, ECHO study team decided to study all other contraceptive methods to check if there is any difference among the three highly effective contraceptives. 

“We are glad that the ECHO study has cleared the uncertainty that had lingered for some time now,” UMATI Executive Director Lugano Daimon told ‘The Guardian’ in an interview.

Lugano said, ECHO study was prompted by observation studies that claimed that, there is an association between using some methods of contraceptives specifically DMPA and HIV infections.

“For many years, as the HIV epidemic increased in many countries, a number of observational research studies suggested a possible increased risk of HIV acquisition for women using progestogen-only injectables, particularly DMPA-IM.”

 

He said that observational studies had some limitations, in the design, however, and hence it was not possible to determine whether HIV infections were due to the type of contraceptive method used or other factors like engaging in unprotected sex or any other means of transmission.

The results of the ECHO trial are the most robust to date that address these concerns, have robust scientific evidence about the potential relationship between hormonal contraception and the risk of HIV from a rigorous randomized clinical trial,” according to Professor Helen Rees, Executive Director of Wits Reproductive Health and HIV Institute at the University of Witwatersrand in Johannesburg, South Africa, and a member of the five-person ECHO Management Committee that leads the ECHO Study.

She said, the results on this question are reassuring, but their findings are also sobering, because they confirm unacceptably high HIV incidence among young African women, something which Dr Cecilia Makafu from UMATI suggests that women need more counseling as some might believe that once they are protected from pregnancy by contraceptives they are also protected from HIV infections.

It has been explained that during the trial, 397 of the women who took part in the study acquired HIV.

For his part IPPF Director General Dr Alvaro Bermejo has welcomed the publication of the results of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial – but warned they show how much more must be done urgently to combat HIV acquisition and offer real contraceptive choice.

The ECHO Study was carried out in four countries with settings of high HIV incidence ‒ Eswatini, Kenya, South Africa and Zambia. A total of 7829 sexually active HIV-negative women aged 16 to 35 years who wanted to use a modern method of contraception were enrolled and were randomly assigned to one of the three methods.

All women who participated in the study received ongoing health services, including counselling on HIV prevention and care, screening and treatment for sexually transmitted infections.

Dr Bermejo said: “This has been an extremely important trial and we are pleased to see the results published. We do need to analyse them in greater deal, but it is already clear that the high rates of HIV and STI infections among those women who took part - despite individualised prevention efforts - represent an urgent cry for the integration of sexual and reproductive healthcare and HIV prevention.

Expanding quality-assured contraceptive options is critical in reducing the current unmet need. Providing a wide choice of acceptable and effective contraceptive methods empowers girls and women to make their own decisions about whether and when they wish to become pregnant as well as how many children they wish to have. Enabling women and girls to make informed decisions is a fundamental principle when providing contraceptive information and services. The study findings support continued access to all methods studied by all women including those at high risk of HIV infection.

WHO, UNAIDS and UNFPA has welcome the results, The World Health Organisation has immediately initiated a process of updating and synthesizing all the evidence on use of contraception and HIV infection risk. As is standard practice when important new research findings are published relating to contraceptive safety, WHO will convene a Guideline Development Group to examine the updated evidence on links between the use of various hormonal contraceptive methods and women’s risk of HIV acquisition. The Guideline Development Group will meet at the end of July 2019 to assess whether current WHO guidance needs to change in the light of the updated evidence.

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