Birth control, HIV link

Women using hormonal birth control, especially progesterone injections, are twice as likely to be infected with, or transmit, HIV, the results of a study published in the Lancet Infectious Diseases journal show.

But a co-author of the study, Professor Helen Rees, of Wits University's Reproductive Health and HIV Institute, said that not all studies show a link between hormonal birth control and increased risk of HIV transmission. She said the connection between the use of the hormone progesterone and HIV infection "is a grey area".

The conclusion of the study was that women must be told "about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods", and about the importance of condoms. In response, the World Health Organisation held a meeting in Geneva of 75 international experts who decided that the evidence was inconclusive.

In a recent press release, the organisation said women at high risk of HIV could safely use hormonal contraceptives. Former AIDS adviser to Unicef Paula Donovan said that the press release was not true because the scientists had agreed that the data were inconclusive.

 She said the organisation had kept women in the dark about the risk of injectable contraception. Rees, who attended the organisation's meeting, said a "room full of experts" agreed that the data were "troubling" and "inconclusive", and more research was needed. She said doctors did not want to stop women using a contraceptive that worked "when there are no alternatives on offer" and more research might show it to be safe.

But Donovan said that the organisation was violating the rights of the 12 million women using the contraceptive injection in sub-Saharan Africa by withholding the information. She said the organisation had known for years about research that showed that progesterone injection increased risks of catching chlamydia and gonorrhoea.

Progesterone thins the vaginal wall, making it more susceptible to infiltration by the HI virus, and suppresses the immune system. Donovan said that every woman who received an injection of hormonal contraceptive must also be given a three-month supply of male or female condoms.

The Department of Health's Eddie Mhlanga said its message remained that condoms must be used in conjunction with other birth control methods.

Katharine Child: The Times, 2 March 2012