Depo-Provera, a popular and highly efficacious hormonal contraceptive, has been linked to increased risk of HIV infection in certain global regions where HIV transmission is still highly problematic. Depo-Provera is an injection of synthetic progesterone administered every twelve weeks, totaling four injections each year. It exhibits its contraceptive action by inhibiting follicle maturation and suppressing ovulation, two events that occur naturally during the midpoint of the normal menstrual cycle. This contraceptive, however, also alters the female genital mucosa in a manner that allows for HIV to easily interact with immune cells which can ultimately initiate a productive infection.
Several epidemiological studies have evaluated the link between HIV infection risk and Depo-Provera use in women with many studies reporting a significant association between the two. This is of particular concern in regions of the world where the majority of new infections occur in women living in communities where the rate of HIV transmission is high and Depo-Provera is the preferred contraceptive choice. Women typically choose this birth control method because it is long acting (requiring only four yearly visits to the doctor), highly effective and discreet.
So, is it possible to help women prevent unwanted pregnancy without increasing the risk of becoming infected with HIV? Should they be told to use condoms in addition to Depo-Provera? This seems like a plausible solution, however, women do not always have explicit control over the sexual encounters they might be faced with. This question can be answered, at least in part, by allocating research funding towards scientific studies that investigate alternative contraceptive methods that will not increase the risk of becoming HIV-infected while conferring protection from unwanted pregnancy.
Few studies have investigated the influence of contraceptive pills on HIV infection risk. Unfortunately, studies such as these have produced conflicting results in that some report an elevated risk while others show no evidence of contraceptive pills having any influence on the risk of becoming infected. There are also virtually no studies that investigate the influence of intrauterine devices or intravaginal rings on susceptibility to HIV, although these birth control methods are newer to the market. Other potential approaches include incorporating virucidal therapeutics into hormonal contraception regimens. In this view, women would be protected from both unintended pregnancy and HIV infection.
Nevertheless, regardless of the method of approach, this public health issue deserves more attention and women should not have to choose between an unwanted pregnancy and becoming infected with HIV.
References:
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2814%2971052-7
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