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October 4, 2011

UPDATED Contraception and HIV Risk Raises Need for Alternative of NFP AND Better Maternal Care

 
“Safe and effective family planning services are central to initiatives to reduce uninteneded pregnancies, promote economic development, and improve the health of women and children worldwide.”  But what if one of the most common forces of family planning methods in Africa was actually increasing the transmission of HIV in heterosexual couples?  This was the conclusion of a very recent article published in The Lancet Infectious Diseases journal.   This article, entitled “Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study” was published by group of researchers from the University of Washington.  In this study, the y followed nearly 3900 couples in Africa.  In each of these couples, one or the other partner was infected with HIV-1, but had not developed an AIDS defining illness. 
The original study was not intended to look at the relationship of contraception and HIV, but it did follow the use of contraception among the couples.   Using this data,  and controlling for many variables, including condom use, the researchers found that in the couples where hormonal contraception was being used versus no hormonal contraception, it was twice as likely that HIV would be transmitted from one partner to the other.  Moreover, this is the first study that has shown an increased transmission of HIV from women to men when hormonal contraception is being used.  This study also showed that the possible mechanism for increased transmission is in changes in the endocervical concentrations of the HIV virus, which is higher in women on hormonal contraception than those who are not (but there is no difference in the blood levels of HIV). 
Despite some of the limitations of this article, including the self reporting of contraception use, the data appears to be very reliable.  Even in regards to the self reporting, the researchers met with the couples every three months, and excluded those who failed to come to these appointments or who did not complete the necessary parts of the visit.  It would be very difficult to design a better study than this without pragmatic and ethical issues arising. 
This study has far reaching implications.  In fact, this study, along with other previous studies, has finally caused the World Health Organization to convene a meeting to discuss this very issue.  From the recent NY Times article:
The study, which several experts said added significant heft to previous research while still having some limitations, has prompted the World Health Organization to convene a meeting in January to consider if evidence is now strong enough to advise women that the method may increase their risk of getting or transmitting H.I.V.
“We are going to be re-evaluating W.H.O.’s clinical recommendations on contraceptive use,” said Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s department of reproductive health and research. Before the meeting, scientists will review research concerning hormonal contraceptives and women’s risk of acquiring H.I.V., transmitting it to men, and the possibility (not examined in the new study) that hormonal contraceptives accelerate H.I.V.’s severity in infected women.
“We want to make sure that we warn when there is a real need to warn, but at the same time we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women,” she said. “This is a very difficult dilemma.”
Consider that last paragraph once again.  we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women.”  Despite this evidence that this research provides, the individuals who take the lives of these women into their hands do not want to rush anything.  Is this because there is so much money involved? Both on the pharmaceutical side and the non-governmental organizations who are the ones delivering the contraceptives to these women?  Is also because it would force an ideological shift on the views of contraception and its relative risk in comparison to actually having children? 
The commentary that is coming out on the web about this study keeps coming back to the same point: What alternative do these women have? How can we reduce maternal mortality and increase their quality of life if they do not have access to contraception? Isn’t this more important than a slight increase in the risk of contracting HIV? 
This same ideology is present in the research article as well.  But there are those who can look beyond the ideology, and realize that many of the presuppositions are false.  Access to artificial contraception and abortion are not the answers to maternal mortality and improved quality of life for these couples.  Nor do the couples have no alternative if they desire to space their children.  What the world forgets (or ignores) are the fertility awareness methods of family planning.  Methods like the Billings Ovulation Method, or Symptothermal Method, or Creighton Method.  There are even methods that have been developed by the Family of the Americas specifically designed for agrarian cultures and women in lower socioeconomic situations.  All of these are extremely effective and would be an excellent alternative to methods of family planning that have numerous side effects, including the increased risk of contracting HIV, for both the man and woman! 
This study is robust and reliable, and should be causing medical professionals and those who care for people with HIV to be crying out for something to be done.  People cannot ignore what science is telling us simply because it would be inconvenient to the Western world’s vision for the developing nations. Rather, they should be demanding that the WHO and the UN and all those who are involved in the distribution of hormonal contraceptives in Africa and around the world to immediately review this issue and to stop putting these couples at risk.
 
UPDATED: 
Simcha Fisher had an excellent post in regards to the Lancet article. 
She says:

“How about offering more aid for safe childbirth?  Maternal and neonatal death is often easily preventable with basic care.  The postpartum African woman who is septic or hemorrhaging to death does not need a shiny new type of contraceptive.  She needs help.  She needs basic medical supplies. 
She shouldn’t have to choose between barrenness and death.”


 
I could not have said it better myself.

Read more: http://www.ncregister.com/blog/simcha-fisher/dying-women-dont-need-contraception/#ixzz1a6PYMR4h

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