MINISTRY OF PUBLIC HEALTH AND SANITATION
Statement on Hormonal Contraception and HIV transmission in Women
The Ministry of Public Health and Sanitation wishes to clarify issues arising from recent media articles on the effect of injectable hormonal contraception and the risk of HIV infection. This has caused alarm, panic and confusion among the general public. We would like to state the following:
Results published by Heffron et al. in the online version of The Lancet Infectious Diseases journal on 3rd October 2011 from a study involving couples with at least one member who was already infected with HIV suggested that the use of hormonal contraception, specifically the injectable Depo Provera among this population, may double the risk of HIV acquisition among previously uninfected women, and may double the risk of HIV transmission by an infected woman to her previously uninfected male sexual partner.
This study is one of the several studieson hormonal contraception and the risk of HIV acquisition and transmission among HIV sero-discordantcouples (i.e., couples in which one partner is HIV+ and the other is not). To date, 13 studies have been published and five have suggested some association while the rest have not. Similar to previously publishedstudies addressing this potential association, the data were observational, which may contain selection bias. In other words, women who use hormonalcontraception may differ from non-users with regard to risk of HIV infection. For example, they may be less likely to use condoms. The 13 new HIV infections that were recorded was a small number thus difficult to base definite conclusions.
Limitations associated with this study emphasize the need for thorough reviewof the available body of evidence on the topic, so as to weigh the risks and benefits of hormonal contraceptive use forwomen at risk of HIV and those who are already HIV infected.
Currently, systematic reviews concludethat the weight of evidence does not conclusively indicatethat use of hormonal contraceptionincreases the risk of HIV acquisition, transmissionor disease progression among thegeneral population.
Contraception provides a crucial role in helping women with HIV and those at risk of HIV infection prevent unintendedpregnancies and prevent perinataltransmission of HIV to their infants. In addition, contraceptionprotects women against the adverse social and health consequencesof unwanted pregnancy.
In light of the study by Heffron and colleagues, the Ministry of Public Health and Sanitationis closely monitoring the scientific evidence to confirm the association of hormonal contraception and increased risk of HIV infection, transmission and HIV disease progression.
After more thorough reviewsincluding a planned review by the World Health Organization in January 2012, the Ministrywill update if necessary our guidelines and update our clients, providers and various programs to reflect new scientific evidence.The Ministry will strive to ensure that women, men and couples have access to a wide variety of contraceptive methods and are counselled about known risks and benefits of those methodsto select the most appropriate method for them.TheMinistry is working closely with the global scientific fraternity to seek additional data on these issues.
The Ministry has not changed its policy on the use of hormonal contraception.Users and providers of hormonal contraception are encouraged to continue using these methods, although, as always, we recommend that women wanting no more children use available long-acting or permanent methods. It is important to remember that other than the male or female condom, none of the other contraceptive methods provide any protection against HIV and other STIs. This requires that we provide condoms to couples who are at risk of HIV infection, in addition to another contraceptive method for dual protection.
DR.SHAHNAAZ SHARIFMBS,MMed,MSc
DIRECTOR OF PUBLIC HEALTH AND SANITATION