Bloodborne HIV: Don't Get Stuck!

All the humming and hawing about injectable hormonal contraceptive, Depo Provera, must be very confusing to people who want to know whether they should discontinue using it, continue using it or get advice from a health professional. However, USAID have weighed in with the clear advice to continue using it.

Their brief communication concludes that “USAID does not believe that a change in contraceptive policy or programming is appropriate or necessary at this time”. I find this advice surprising. People who have the combined problem of avoiding conception and protecting themselves against sexually transmitted infections (STI) can always use a different contraceptive method (such as condoms), or combination of methods.

Therefore, people with the luxury of good advice and a wide range of contraceptive methods at their disposal should avail of those. But what about all the people to whom these are not available? They are the most likely to be using Depo Provera, as it is most frequently used by members of ethnic minorities in rich countries and by the general population if poor countries.

The worry is not just about HIV, that’s only one disease. But there have been known side effects relating to the use of Depo Provera since the 1990s. Concerns have even been raised about the use of the drug it contains far earlier than that. If Depo Provera is not generally used by middle class white people in rich countries, why is it still being promoted to non-white people in poor countries, given the long standing and serious concerns about its safety?

Someone has sent me rough calculations on how effective stopping the use of Depo Provera would be in reducing the risk of HIV transmission, compared to UNAIDS’ beloved male circumcision. Circumcising men only reduces the risk of women transmitting HIV to men by quite a small factor. But it substantially increases the risk of men transmitting HIV to women. On the other hand, stopping Depo Provera use reduces the risk of transmitting from men to women and from women to men.

As mentioned above, there are more health issues here than HIV, or even STIs or unplanned pregnancies. So why promote one HIV ‘prevention’ method that will almost certainly increase transmission to women (male circumcision), without reducing transmission to men that much, while also promoting a contraceptive method that increases transmission in both directions (Depo Provera, and perhaps other hormonal contraceptives)?

In developing countries there is also the issue of unsafe healthcare, the as yet unaddressed problem of reused injecting equipment. This may or may not be a factor in the association between injectable Depo Provera use and increased HIV transmission risk. As there have been no investigations of possible transmission of HIV or other blood-borne diseases in Africa through unsafe healthcare, perhaps USAID will also clarify this matter while they are considering Depo Provera (if they are still considering Depo Provera).