Hormonal contraception and HIV acquisition: study finds no overall association.

Imagine Caroline, a 23-year-old, married woman from Zimbabwe who--like more than a third of women in that country using contraception--takes an oral contraceptive pill each day. By preventing pregnancy at a time in her life when she is not ready to start a family, this highly effective contraceptive provides her with not only peace of mind but also the opportunity to pursue an education and to anticipate the benefits that an education affords. Yet, she worries. Zimbabwe is a place where HIV infection is a clear danger: nearly a quarter of adult Zimbabweans are infected. And Caroline, like so many women in settings where HIV prevalence is high, has heard rumors that use of hormonal contraception may increase her risk of becoming infected with HIV if she is ever exposed to the virus. A thoughtful young woman, she weighs the possible risks and known benefits of continuing to use oral contraception. The idea of acquiring deadly HIV is chilling, and she cannot dismiss it. But she does not want to become pregnant, so she turns to her family planning provider for advice. "What should I do?" she asks.

With some degree of certainty, the provider can now tell her that she does not need to abandon hormonal contraception. This advice is based on new data from the largest prospective study ever conducted on the association between hormonal contraceptive use and HIV acquisition among typical family planning users. The research, funded by the U.S. National Institute of Child Health and Human Development, was conducted by FHI and collaborating institutions* among some 6,100 family planning clients in Uganda, Zimbabwe, and Thailand. The four-year study, published in the January 2, 2007 issue of the journal AIDS, found no overall association between the use of either combined oral contraceptive (COC) pills or depot-medroxyprogesterone acetate (DMPA) and HIV acquisition. (1)

This finding--generated by a study with unique methodological strengths when compared with previous studies on the topic (see article, page 5)--is reassuring for women in need of highly effective contraception in settings of high HIV risk. Neither the World Health Organization (WHO) nor the International Planned Parenthood Federation, which have reviewed the study results, plans at this time to change its guidelines for hormonal contraceptive use by such women. In June of 2005, the WHO Family Planning Guideline Steering Group issued a statement that "the study results are reassuring and that the new evidence does not modify the current guidance for contraceptive use," which states that women at risk of HIV infection or those who are HIV-infected may safely use hormonal contraception. (2)

The study also examined whether sexually transmitted infections (STIs) modified the relationship between hormonal contraceptive use and HIV acquisition. Among ...