By Esther Nakkazi
The good news from the long-awaited trial on a link between hormonal contraceptive methods use and increase in the risk of HIV acquisition has brought a sigh of relief, will boost confidence for family planning and reassures women who are at the centre stage.
The results are reassuring at many levels and a winner for all women using contraceptives and those intending to use them, the men who support their partners to use them, the providers who now have more confidence in dispensing them, the researchers and the funders who ensure they are forever available on the market.
We now know that there is no HIV risk for women using the injectable depot medroxyprogesterone acetate (DMPA), the implant Jadelle and the copper intrauterine device (IUD) according to results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomised clinical trial.
It is NOT contraception that puts women at a risk of HIV.
ECHO adds the most robust data about contraception safety and effectiveness with solid evidence. It is a much better world for women to know that none of these 3 methods increase the risk of acquiring HIV.
DMPA or Depo is an injection given into the muscle. It is given every 3 months there may be a 6-9 month delay in getting pregnant after the last injection. Jadelle has 2 thin, flexible rods filled with progestogen inserted under the skin of a woman’s upper arm. It lasts up to 5 years but can be removed any time with a rapid return to fertility once removed.
The copper IUD has a ‘T’ shape and is made of soft but strong plastic with copper bands and has a ‘tail’ made of 2 strings. The health worker places it in the womb and it can last up to 10 years, although it removed at any time and fertility returns immediately.
In Uganda two of these researched methods, Jadelle and depot are the two highest used contraceptives by women which help them put off unwanted or avoid high-risk pregnancies, space childbirth, prevent maternal and infant deaths every year.
In the countries where the ECHO randomized clinical trial took place, at the 12 sites in Eswatini, Kenya, South Africa, and Zambia depot is the number one choice. Women love it because it is discrete and in not all but some circumstances the shot is the only long-acting option on the shelf.
It is good to know that the contraceptives under the ECHO study were highly effective and acceptable further endorsing their primary purpose. The study says participants used either of the three methods assigned to them for 92% of the time they were in the study.
However, we should know that over 150 million women worldwide use modern methods of contraception for family planning and some do not necessarily use the three methods in the ECHO trial so these results cannot be generalised to other contraceptive methods that were not included in the study.
Unfortunately, the study had high HIV incidence and high Sexually Transmitted Infections (STIs) recorded among the 7,800 women who participated yet they were given an optimised level of prevention.
Except for condoms, no contraceptive method protects against HIV or other STIs, and thus women at risk of HIV infection who are using contraception should also be advised to use condoms.
Moving forward we know now that Depot, Copper IUDs and Jadelle has nothing to do with the HIV infection it is high time to invest more in programs to protect women against HIV.
Isn’t it logical that HIV prevention services and family planning should be integrated? African governments can also avail more funding for contraceptives and HIV prevention and enforce that the two are provided in one place.