Hormonal Contraception, Sexually Transmitted Diseases, and Risk of Heterosexual Transmission of Human Immunodeficiency Virus Type 1

Abstract

To examine associations between method of contraception, sexually transmitted diseases (STDs), and incident human immunodeficiency virus type 1 (HIV-1) infection, a prospective observational cohort study was done among female sex workers attending a municipal STD clinic in Mombasa, Kenya. Demographic and behavioral factors significantly associated with HIV-1 infection included type of workplace, condom use, and parity. In multivariate models, vulvitis, genital ulcer disease, vaginal discharge, and Candida vaginitis were significantly associated with HIV-1 seroconversion. Women who used depo medroxyprogesterone acetate (DMPA) had an increased incidence of HIV-1 infection (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.4-3.4). In a multivariate model controlling for demographic and exposure variables and biologic covariates, the adjusted HR for HIV-1 infection among DMPA users was 2.0 (CI, 1.3-3.1). There was a trend for an association between use of high-dose oral contraceptive pills and HIV-1 acquisition (HR, 2.6; CI, 0.8-8.5).

Population-level impact of hormonal contraception on incidence of HIV infection and pregnancy in women in Durban, South Africa

“…[12][13][14][15] The relatively small effect size in our study was statistically significant in both the adjusted and unadjusted analyses because of the study's high statistical power (> 90%). However, the population-level impact of the use of hormonal contraceptives on HIV-1 infection rates was determined to be only 12% in adjusted analyses.…”

“…[12][13][14][15][16][17] These findings were supported by a subsequent study by Heffron et al that provided new evidence suggesting an increased risk of contracting and transmitting HIV-1 infection associated with the use of hormonal contraceptives, particularly injectables. 18 Durban data from the MDP301 trial confirmed this.…”

“…[12][13][14][29][30][31] Conflicting study outcomes have triggered doubts regarding the role of injectable contraceptives and their use in developing countries. [12][13][14][15][16][17][18] It is critical to determine to what degree hormonal contraceptives increase the risk of HIV-1 infection. Although studies designed to address this question may be complex and difficult to implement, such difficulty must be weighed against their potential impact on HIV-1 acquisition.…”

Birth intervals and injectable contraception in sub-Saharan Africa

“…Data from successive Demographic and Health Surveys (2) undertaken in nine subSaharan African countries were used: Burkina Faso (1992 and 1999), Cameroon (1991 and 1998), Ghana (1993 and1998), Kenya (1993 and1998), Madagascar (1992 and1997), Malawi (1992 and2000), Niger (1992 and 1998), Tanzania (1992Tanzania ( , 1996Tanzania ( and 1999, and Zambia (1992, 1996 and 2001). The percentages of women reporting a preceding birth interval of ≤ or > 24 months were tabulated by country and survey date with the percentages reporting current use of any modern reversible contraception, DMPA and the intrauterine device.…”

Vulvo-vaginal candidosis in a cohort of hormonal contraceptive users in Ibadan, Nigeria

“…Hormonal contraception has been proven as one of the biological factors being linked to the acquisition of Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs). (5,6) In a study conducted among a cohort of female sex workers in Kenya, compared with those who don't practice contraception; those who rely on oral contraceptives (OCPs) are more likely to acquire chlamydia infection or vaginal candidiasis, but are less likely to acquire bacterial vaginosis. (6,7) The assumptions are that the cervical ectopy produced by oral contraceptives (OCPs) results in affected cervical -zone being more vulnerable to trauma and thus perhaps to HIV infection.…”