Bloodborne HIV: Don't Get Stuck!

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Some people who accept evidence Depo increases women’s risk to get HIV by 40% NEVERTHELESS continue advocate Depo for women in Africa.

Such Depo advocates argue that women who use Depo might get HIV and might even infect their babies, but if they don’t use Depo, they will be more likely to die during childbirth[1]: “Women living in sub-Saharan Africa cope with both high rates of HIV infection and high rates of pregnancy-related maternal death relative to the rest of the world. Based on the most current estimates, our model suggests that removal of POI [progestin-only injectables, ie, mostly Depo] contraception from the market without effective and acceptable contraception replacement would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios.”

This excuse overlooks several issues, including:

1.  THE CHOICE BETWEEN RISKS TO GET HIV WITH DEPO OR TO DIE FROM AN UNWANTED PREGNANCY IS SOMETHING THAT SHOULD BE LEFT FOR WOMEN TO DECIDE. IT’S NOT SOMETHING FOR EXPERTS TO DEBATE AND DECIDE FOR WOMEN.

2. Compared to family planning programs that offer women a wide range of methods for birth control and have low rates of population increase, programs that promote mostly Depo are likely to be less effective. In a US study, almost half of women who used Depo quit, whereas 30% quit the pill and 9% quit condoms.[2] If women can’t find a method they like, they are less likely to practice birth control. Around the world, in countries with low population growth, no or low percentages of women use Depo.[3] Other methods are associated with better family planning success.

3. Why assume current rates of maternal mortality in Africa? Why not emphasize cutting maternal mortality?

Given the evidence, the challenge for birth control advocates is to increase women’s access to safer options.

References

1. Rodriquez MI, Gaffield ME, Han L, et al. Re-evaluation the possible increased risk of HIV acquisition with progestin-only injectables versus maternal mortality and life expectancy in Africa: a decision analysis. Global Health: Science and Practice 2017; 5: 581-591. Available at: http://www.ghspjournal.org/content/5/4/581 (accessed 2 April 2018).
2. Daniels K, Mosher WD, Jones J. Contraceptive methods women have ever used: United States, 1982-2010. National Health Statistics Reports, no 62, 14 February 2013. Available at: https://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf (accessed 2 April 2018).
3. United Nations, Department of Economic and Social Affairs, Population Division (2017).  World Contraceptive Use 2017 (POP/DB/CP/Rev2017). Available at: http://www.un.org/en/development/desa/population/publications/dataset/contraception/wcu2017.shtml (accessed 20 February 2018).