Bloodborne HIV: Don't Get Stuck!

A recent study indicates that use of injectable hormonal contraceptives, such as Depo Provera, may double transmission of HIV from HIV positive men to women receiving the injections and also from HIV positive women receiving the injections to HIV negative men with whom they have unprotected sex.

A family planning expert in Rwanda, Dr Thomas Nsengiyumva, finds the study to be misleading. He points out that one sexual partner must be HIV positive for this doubling of risk to occur, and they can reduce the risk considerably by using condoms.

This is true; no sexual contact between HIV negative couples gives rise to HIV transmission; and using condoms consistently and properly always reduces the risk of pregnancy and sexual transmission of HIV and other sexually transmitted infections.

Pathfinder International, who receive large amounts of funding (annual budget of over 100 million dollars) to promote family planning and reproductive health information and training in developing countries have also expressed their scepticism about the study. I agree with them that “premature speculation” can be dangerous. But this speculation doesn’t come from nowhere: it comes from the uncertainty that the HIV industry has created by not giving clear or convincing advice to users of the injectable drug.

If Pathfinder are really concerned about mother to child transmission of HIV, as they claim to be, there are far better ways of addressing that than by simply doling out various family planning commodities.

The HIV status of one or both partners in a relationship may not be known, or it may change without one or either partners being aware. So, in partnerships where one partner is known or suspected to be infected with HIV, or who may become infected, would it not be better for the female partner using injectable hormonal contraceptives to give up doing so and to rely on condoms, or some other method or combination of methods?

Findings about hormonal contraceptive drugs going back many years, decades even, show that they are questionable, that they have other risks besides HIV transmission. The most recent findings seem more like another nail in the coffin for such methods, at least until their safety has been assured. Injectable Depo Provera and similar drugs have not been shown to be safe.

Would people in Western countries accept the ‘reassurances’ of WHO that women should continue using Depo Provera until they have had time to discuss the issues? I think the advice to people would be immediate, however lengthy the discussions need to be. But, as it happens, most people in Western countries don’t use injectable hormonal contraceptives, unless they are poor or of African descent, or both, as is often the case.

The ‘dilemma’ seems to be: stop using the drug and risk unplanned pregnancy OR continue using the drug and risk unplanned pregnancy AND HIV transmission? Condoms and other methods are available, effective and cheap and can be used on their own or in combination, with reference to the specific needs of each user. Is that really such a dilemma?

The HIV industry constantly implies that everyone in high prevalence countries in Africa is at risk of being infected with HIV and that no one knows what their partner is up to. Therefore, anyone on Depo Provera or similar needs to understand the additional risk that the injectable version of the drug adds to their existing high level of risk.

If I was in a relationship with someone taking the injectable drug, or if I was taking it myself, I would not be waiting till January, till the World Health Organization decides “if evidence is now strong enough to advise women that the method may increase their risk of getting or transmitting HIV”. I’d find another contraceptive method, at least temporarily. People need clear and convincing advice. Why should they wait?