Birth control injections put ‘women in HIV danger’

By Tom Mosoba and Agencies
Dar es Salaam. Medical experts are warning that a popular hormonal family planning injection commonly used by women could be exposing couples to the risk of acquiring the virus that causes Aids.

In new research findings, scientists say they have found evidence suggesting that the injectable contraceptives have biological properties that may make women and men more vulnerable to HIV infection.
The study carried out in eight African countries, including Tanzania, could pose a major dilemma to public health authorities and also disrupt family planning efforts among the many poor countries where the vaccines are already wide spread.According to the World Health Organisation (WHO), about 12 million women between the ages of 15 and 49 in sub-Saharan Africa, roughly six per cent of all women in that age group, use injectable hormones.

In Tanzania, slightly more than six per cent of those on family planning use the injection method. A majority,  however, prefer pills (oral) and a small percentage use condoms and other natural means such as withdrawal or abstinence as advocated by faith-based organisations.

Recent government statistics indicate that between 31 to 40 per cent of women are on contraceptives in leading regions of Dar es Salaam, Kilimanjaro, Arusha and Ruvuma while family planning is least in Tabora, Shinyanga and Mwanza, where a paltry 10 per cent of women use any family planning methods, followed closely between 10 t0 20 per cent by Kigoma, Singida, Mara, Rukwa, Coast, Kagera and Mjini Magharibi in Zanzibar.    

Yesterday, the minister for Health and Social Welfare, Dr Hadji Mponda, told The Citizen in a telephone interview that the government could not immediately give its position before studying the report.

“I am currently on Safari and therefore not in a position to issue an official reaction because the information is sensitive, even though it is vital that the public know our stand,” Dr Mponda said in a telephone interview. He referred any questions to technocrats at the ministry.

However, the permanent secretary, Ms Blandina Nyoni, and the government chief medical officer, Dr Deo Mtasiwa, could not be reached as their mobile phones went unanswered for most of the day yesterday.
Separately, Dr Ross Kinemo, the Principal of Mzumbe University’s Mbeya College campus, said there was likelihood that there could be some truth in the research findings. “I personally would be inclined to agree with the research findings that the injections could pose such risks.”

“What I am not sure about is to what extent that is the case because there may be other factors as well,” said Dr Kinemo, who in the past studied abortion in Tanzania and the family planning legal framework.  He spoke on phone from Mbeya.      
The contraceptives use and HIV report was first made public at the last international Aids conference, but has gained traction this week, with its publication in The Lancet Infectious Diseases, a major peer-reviewed medical journal.

The study was led by researchers at the University of Washington and involved 3,800 couples in Tanzania, Botswana, Kenya, Rwanda, South Africa, Uganda and Zambia. The Kilimanjaro Christian Medical Centre (KCMC) was the base for the local investigation as were Makerere and Nairobi universities for Uganda and Kenya, respectively.

According to the study, in each couple, either the man or the woman was already infected with HIV. Researchers followed most couples for two years, had them report their contraception methods, and tracked them to see whether the uninfected partner contracted HIV from the infected partner, said Dr Jared Baeten, an author and an epidemiologist and infectious disease specialist.

The scientists found that women using hormonal contraception became infected at a rate of 6.61 per 100 person-years, compared with 3.78 for those not using that method. Transmission of HIV to men occurred at a rate of 2.61 per 100 person-years for women using hormonal contraception compared with 1.51 for those who did not.

The New York Times reported in its yesterday online edition that Pfizer, the manufacturer of the branded version of the injectable, Depo-Provera, declined to comment on the study, saying officials had not yet read it. The study’s authors said the injectables used in Africa were probably generic versions.

While at least two other rigorous studies have found that injectable contraceptives increase the risk of women’s acquiring HIV, the new research has some strengths over previous work, said Charles Morrison, senior director of clinical sciences at FHI 360, a nonprofit organisation whose work includes researching the intersection of family planning and HIV.

Those strengths include the fact that researchers followed couples and were therefore able to track transmission of HIV to both men and women. Dr Morrison said only one other less rigorous study had looked at whether hormonal contraception increased the risk of infected women’s transmitting the virus to men.

Although the study has limitations, including its use of data not originally intended to determine the link between contraceptive use and HIV, “I think this does raise the suspicion” that injectable contraceptives could increase transmission risk, he said.

Why that would occur is unclear. The researchers recorded condom use, essentially excluding the possibility that increased infection occurred because couples using contraceptives were less likely to use condoms.