Peat said:
OCDC could you comment on this?I hadn’t heard of this before so did some research.There is increasing evidence that the method of contraception favoured by family planning organisations in Africa and elsewhere facilitates the transmission of HIV. The method is progesterone injection, most commonly in the form of DMPA (Depo Provera) or NET-En (Noristerat). WHO made an announcement about it at the recent Melbourne International Aids Conference, where the results of a highly relevant study were presented, but vested interests are determined to keep the status quo. Motherhood remains risky because of a disproportionate amount of effort going into contraception at the expense of maternal health.
S. Mthembu, South Africa said:
Sexual and reproductive rights of womenI thought this might’ve been a begged question, so did some more research.S. Mthembu opened by acknowledging that women are entitled to sexual and reproductive health (SRH) and rights, and that this is an obligation of the state. She reflected that discussing pleasure within this context is rare and noted that often in SRH programs there is an almost exclusive focus on reproductive as opposed to sexual rights, reflecting the fact that women, by and large, are viewed more as reproductive beings than as sexual beings. Further when sexuality is addressed it is often solely focused on the potential negative consequences of sex such as STIs, unwanted pregnancy, and HIV. Despite being the “other side of the same coin,” pleasure is rarely if ever part of the conversation.
Mthembu reflected an overall feeling that regardless of pleasure, many scientific inventions such as condoms were inherently difficult to use because of the challenges in negotiating condom use. With respect to female condoms, she proposed that a technology meant to be used by a woman on her own body – which may be seen by the other gender as a commodity that she herself does not own – may be even more difficult than negotiating male condoms. In other words a woman saying “I have a condom” is also saying “I own my own body,” which could create a problem in the bedroom for her.
With respect to non-condom based technologies Mthembu pointed out a number of serious drawbacks, highlighting how addressing women’s sexual health and pleasure in a piecemeal fashion (technology by technology) results in women being left behind. Research on microbicides – often spoken of like a magic bullet that you can use without anyone knowing as many as 8 hours before sex – is progressing at a very slow pace, which is a reflection of a lack of investment in the field and a general sense that women with HIV have been excluded from research. Other technologies also have their own downfalls: HPV vaccines may result in a partial reduction in risk of HIV transmission, but this doesn’t matter much when someone’s socioeconomic status dictates whether they get it. Depo-provera, on the other hand, is provided widely but is known to interfere with the vaginal environment and could actually increase women’s risk of contracting STIs and HIV.
Mthembu concluded by saying that if condoms haven’t been the solution for women in the past three decades, they alone will never be the solution. She advocated for the inclusion of safe contraceptives and STI treatment as part of HIV prevention, and that nurses and doctors much take this to hard and start actually looking into women’s vaginas rather than automatically treating them with antibiotics for STIs at any mention of vaginal discomfort.
Murphy et al said:
Research Gaps in Defining the Biological Link between HIV Risk and Hormonal ContraceptionA critical emerging issue that may impede efforts to control and reverse the HIV pandemic is the findings from multiple epidemiological studies that link the use of depot medroxyprogesterone acetate (DMPA), a progesterone-based contraceptive used by an estimated 35 million women worldwide,1 with an increased risk of acquiring or transmitting HIV and other sexually transmitted infections (STI).2–4 One basis for these concerns is epidemiological analysis of data collected in the Partners in Prevention HSV/HIV Transmission Study, which was conducted in seven countries in Africa. In a secondary analysis from this study, women using DMPA were at significantly increased risk of acquiring and transmitting HIV compared with women not using hormonal contraception; however, the primary study was not designed to address the impact of HC on HIV risk.5
(Interesting article follows)
1. Hel Z, Stringer E, Mestecky J. Sex steroid hormones, hormonal contraception, and the immunobiology of human immunodeficiency virus-1 infection. Endocr Rev. 2010;31:79–97.
2. Phillips SJ, Curtis KM, Polis CB. Effect of hormonal contraceptive methods on HIV disease progression: a Systematic Review. AIDS. 2013;27:787–794.
3. Polis CB, Phillips SJ, Curtis KM. Hormonal contraceptive use and female-to-male HIV transmission: a systematic review of the epidemiologic evidence. AIDS. 2013;27:493–505.
4. Butler AR, Smith JA, Polis CB, Gregson S, Stanton D, Hallett TB. Modelling the global competing risks of a potential interaction between injectable hormonal contraception and HIV risk. AIDS. 2013;27:105–113.
5. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, de Bruyn G, Nakku-Joloba E, Ngure K, Kiarie J, Coombs RW, Baeten JM. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2012;12:19–26.