Does hormonal contraception increase the risk for a woman to acquire HIV from an infected partner?
This topic, with implications for public health in countries where HIV risk is high, has been contentious. Some previous studies had found the answer to be yes, for methods involving injectable progesterone such as Depo-Provera. This led the World Health Organization in 2012 to advise women using progesterone-only injections to use condoms to prevent HIV infection.
At the recent AIDS 2014 meeting in Australia, Emory epidemiologist Kristin Wall presented data from public health programs in Zambia. This is another study emerging from the Zambia-Emory HIV Research Project directed by Susan Allen.
Wall’s presentation is available here.
Studying 1393 heterosexual couples with a HIV-positive male partner over 17 years, Wall and her colleagues found no significant difference in incidence rate per 100 couple years between hormonal and non-hormonal forms of contraception. Read more
In the HIV/AIDS arena, theÂ idea of “treatment as prevention” has been gaining strength. Multiple studies have shown that treatment with anti-retroviral drugs can dramatically reduceÂ the likelihood that someone infected with HIV will be able to pass the virus to someone else.
However, a recentÂ strategy documentÂ for HIV/AIDS prevention developed byÂ aÂ International Antiviral Societyâ€“USAÂ panel, co-led by Rollins Global Health chair Carlos Del Rio, puts biomedical interventions hand in hand with psychosocial measures such as couples counseling and treatment for drug dependence.
Why? Because people everywhere can have trouble sticking to antiretroviralÂ treatment, even if drugs are available. And couples counseling by itself is valuable.
A powerful example of how this plays out, and of the importance of couples counseling to the effectiveness of antiretroviral drugs in prevention, comes fromÂ a recent presentation fromÂ Emory epidemiologist Kristin Wall at the AIDS 2014 meeting in Australia. The website NAM AidsmapÂ had a helpful write-up of her presentation, which isÂ available here.Â Thanks to co-author Susan Allen for alerting us to this.
CVCT (couples voluntary counseling and treatment) greatly enhanced the preventive effect of antiretroviral treatment, when compared to treatment without counselling, Wall’sÂ analysis of a large cohort of couplesÂ in Zambia showed.Â
Update: Allen points out that couples counselingÂ by itselfÂ was effective in helping people avoid HIV, with a 75 percent reduction in incidence for couples where the HIV+ partner was not receiving antiviral therapy or with HIV negative couples.Â Read more