A front-page article in The New York Times recently blared alarming news: the popular injectable contraceptive Depo Provera (a.k.a. “the shot”) may double the risk of getting HIV or passing it to an HIV-negative partner. Sounds scary, right? It’s not a big deal in the U.S., where rates of HIV are extremely low. It might be more of a cause for concern in other countries–particularly in some African countries, where as many as 1 in 5 adults have HIV. The organizations that help provide birth control for many of these countries have announced that the shot should still be available for women who want it. And experts have made it clear that there’s no reason for women in the U.S. to stop using it.
The information comes from a study led by researchers at the University of Washington and conducted in 8 countries in sub-Saharan Africa. The study focused on couples where one partner was already infected with HIV and the other wasn’t. Researchers followed the couples over the course of two years, making note of whether the couples used birth control, what method they were using, and whether or not the uninfected partner contracted the virus in that time.
They found that, compared to women not using hormonal birth control, women who used the shot had double the risk of contracting HIV from an infected partner. They also had double the risk of transmitting HIV to their partner, if the partner started the study without HIV. The scientists think biological changes in the vagina caused by the shot may be the explanation. However, several weaknesses in the study, such as the low number of women using the shot, mean that more research is needed before drawing any conclusions. And the World Health Organization (W.H.O.) agrees: they’ve called for further research about the potential link between the shot and HIV risk.
What about using the shot in countries with really high rates of HIV? It’s not clear that practices should change. For some women, Depo may be the best available option, especially when they live far from the nearest health clinic. Experts point out that for women in the 8 countries where the study was conducted, any risks related to using Depo must be balanced with the risk of getting pregnant. Pregnancy is risky in and of itself and there is very strong evidence that being pregnant increases the risk of a woman getting HIV.
This study does confirm that, regardless of what other contraception couples are using to prevent pregnancy, they need to use condoms to prevent HIV. And that’s a lesson that applies in every country: to avoid STIs, condoms are still your best bet.