Contraceptive Used in Africa May Double Risk of H.I.V.

http://www.nytimes.com/2011/10/04/health/04hiv.html?_r=1&hp

just in case you were all out of outrage, stunned disbelief, or conspiracy theories.

was just skimming this. the first thing i thought of were the more exciting advances in (iirc) spermicidal contraceptive gels?, that were being mentioned a lot a while ago, that would allow autonomous application by women & circumvent some of the social issues w/contraception in some places in africa etc.

back to this, though, i would think that the messaging regarding the findings could be pretty ominous in itself?

Not that I don't love a good outrage about women's health policies, but it says that BOTH the injected and oral contraceptives had the same effect on HIV transmission everywhere in the world, so it's not like the drugs being made for, or sent to, African women are extra high-risk compared to those given others. (Pfizer trying to wash their hands apparently but it doesn't look like they're actually at fault...THIS TIME.)

Moreover, just BEING PREGNANT also increases the risks in a similar way. And hormonal contraceptives mimic BEING PREGNANT. So this will probably end up as/turn into a breakthrough about hormonal contraception at some point, if we ever fund research into that kind of thing again.

Agreed. I don't think that there is any sort of conspiracy or anything at work here. What I worry about most is the implications this could have for women for whom Depo is a largely safe and effective contraceptive that they can use on their own and often without their partners knowledge. Being able to do so allows them to take their family planning into their own hands/control which is pretty crucial considering how problematic unintended pregnancies can be for many of the women we're talking about. I just hope this doesn't turn into a thing where word gets out and scares women out of using Depo without as effective a replacement.

"Dr. Ludo Lavreys, an epidemiologist who led one of the first studies to link injectable contraceptives to increased H.I.V. risk, said intrauterine devices, implants and other methods should be explored and expanded. “Before you stop” recommending injectables, he said, “you have to offer them something else.” - He's right obv but it's sort of strange because I'm p sure that IUDs are known to increase the risk of infection of all STIs including HIV and I imagine that hormonal implants would act in the same manner as Depo?

The non-hormonal IUD would avoid the changes that the article describes, but that's only one option and obv won't work for everyone (although outside of the US, there are models of IUD that are more recommended for nulliparous women than the one we have here). Also, one's partner may be able to detect it and it is physically removable/reversible, although not without some pain and discomfort to the woman, so it still leaves women vulnerable to use of force or pressure from their partners to remove the device.

True but I think the non-hormonal iud is thought to increase the risk of acquiring stds in other ways (changing the environment of the uterus, widening the os). They also make STIs more difficult to cure and the presence of a preexisting STI also icreases the risk of aqquiring HIV. I don't know what effect t, if any, they'd have on f 2 m transmission tho.

Think IUDs are also prob more expensive and a lot less convenient to administer than a shot so they're prob out (sadly) as a realistic alternative for several reasons.

Yeah, that too. You need sterile speculums and various other tools, more than just a disposable clean needle for each patient.

Yep. And time etc. It's just not nearly as efficient.

Wait, were these non-barrier contraceptives being touted as somehow reducing the risk of HIV? Or just that it's a surprise now that they actually increase the risk?

Well, the time thing could hypothetically even out, because the copper IUD is good for 10 years barring expulsion or blah blah. Depo is every 3 mos, iirc? But still doesn't feel practical.

Ya, true.

x-post - It's a surprise now that they actually increase the risk.

"Not that I don't love a good outrage about women's health policies, but it says that BOTH the injected and oral contraceptives had the same effect on HIV transmission everywhere in the world, so it's not like the drugs being made for, or sent to, African women are extra high-risk compared to those given others. (Pfizer trying to wash their hands apparently but it doesn't look like they're actually at fault...THIS TIME.)"

this is true. but its also true that the vast majority of people who die of aids live in africa. so the fact that this form of contraceptive could possibly DOUBLE the chance of someone getting the disease, is pretty important news there.

but, yeah, this isn't good news for anyone.

i think it was really the word "double" that stunned me. not "increased risk", "some increased risk". you know.

What I don't get is what it means to double the risk of a highly communicable infectious disease. Like, how hard is it to get HIV in the first place? Is that a risk lots of folks knowingly take, because the odds are comfortably low enough or something?

Well, in general HIV is a pretty fragile virus and probably harder to contract than you think BUT it's really important to remember that this is being looked at in the context of sub-Saharan Africa where, while they peaked in the late 90s, HIV infection rates are still disproportionally high when compared to the rest of the world. These figures could be a little off the but the last I remember reading the prevalence among adults in S Africa was about 5% whereas, for example, in N America it's around 0.5% (I think). So, the sheer number of infections alone raises a person's chance of coming in contact with an infected individual. Add in things like war, rape, child marriage, preexisting STIs, inability to negotiate condom usage with a partner and other factors and it gets even more complex and is often not really a matter of whether it's risk people knowingly take but rather one that's forced upon them.

These figures could be a little off the but the last I remember reading the prevalence among adults in S Africa was about 5% whereas

it's even higher than that, iirc, and i think it's close to 30% (!!!) in pregnant women

like i think in adults between 25 and 45 it runs from 15-30%. :-/

I think that may have been from when they were at their highest but that they've dropped? I can't remember. Reading this now . . .

http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf

Yeah, I don't know. There are maps that match yr figures but stuff in the text seems to put the number much lower.

Other epidemics in southern Africa have also levelled off at very high levels.
At an estimated 25.9% [24.9%–27.0%] in 2009, Swaziland has the highest adult
HIV prevalence in the world.

OK so I think that in some countries it's still really really high but in others it's declined sharply so maybe the 5% figure is overall for the entire region. I am not a stats person so there is every chance I'm reading it incorrectly but I'm not sure. Man, I need to become a stats person.

the data i saw (http://www.avert.org/safricastats.htm) (also no idea of the quality) looked like prevalence was significantly lower on either side of that age range i gave above. which...makes sense.

anyway this article is curious, and i should probably get around to reading it huh

Yeah, I just downloaded the Lancet one to read later.

Ah ha! I was meaning Southern Africa by S Africa not South Africa. Totally my fault. The stuff I was looking at was for Sub-Saharan Africa as a region whereas I think that's just South Africa which makes sense because infection rates there have always been astronomical. lol. I'm an idiot.

"I was meaning" to learn how to speak English? In any event, you know waht I meant.

aha

But I thought by and large one major reason for the spread of HIV in Africa was the general disregard or disuse of condoms. No? Like, it's not that Africans catch HIV easier than anyone else, but they may be more prone (for cultural, misinformed, whatever) reasons not to do as good a job preventing it. I mean, AIDS rates in the West have dropped down pretty significantly not because people are not engaging in behaviors prone to transmitting HIV, but because they're engaging in these behaviors in a safer manner - clean needles, condoms, etc. No?

I mean, of this list - war, rape, child marriage, preexisting STIs, inability to negotiate condom usage with a partner and other factors - I don't know how one could know for sure but I'd wonder if the last alone (no condoms) accounted for a lot of HIV's transmission in Africa. Though given the horrors of war in so many of these regions, I guess I shouldn't discount the impact of rape, etc.

Which is a roundabout way of asking if, double the chances of contracting HIV or not, the aforementioned contraceptive actually lead to a significantly larger number of HIV cases.

I'd also be curious to know how many of these HIV cases are in children.

Which is a roundabout way of asking if, double the chances of contracting HIV or not, the aforementioned contraceptive actually lead to a significantly larger number of HIV cases

guessing that the study was retrospective, which basically means that they've concluded that yes, the contraceptive was responsible for a statistically significant increase in HIV cases

I'm unclear here, Josh: did you read the article?

I haven't yet, no, because as a non-subscriber I have to limit my Nytimes reading.

Right?

how do ppl not know about the question mark trick at this point

http://www.nytimes.com/2011/10/04/health/04hiv.html?_r=1&hp --> counts toward your 20

http://www.nytimes.com/2011/10/04/health/04hiv.html --> read this a million times if you want

So you just cut out everything after the .html?

drop the question mark and everything after it

I didn't know!

http://posterous.com/getfile/files.posterous.com/pourmecoffee/y0Mtvy595Evs9MXLATZDpNVs9Uv2Rd6uthcGBe19q5IEcao6jKl9ZUFLBYZj/the_more_you_know2.jpg

TY!

work went by SO much faster this summer when i figured that out

Ya. Looking forward to this tbh.