Depo’s Deception: New Dangers for African Women

The Issue

Injectable contraceptives like Depo-Provera increase the risk of HIV transmission. A recent meta-analysis conducted in collaboration with the Population Research Institute reviewed a total of 24 studies published in peer-reviewed journals and found a significant increased risk of acquiring HIV when using Depo-Provera and other injectables.

Injectable contraceptives are commonly used worldwide, particularly in Sub-Saharan Africa where the prevalence of HIV remains high. International aid programs that are providing DMPA contraceptives to areas with high HIV prevalence may be contributing to the spread of AIDS.

What is Depo-Provera and DMPA?

Depo-Provera is a pharmaceutical brand owned by Pfizer, Inc. and is the most widely used injectable contraceptive worldwide. Depot medroxyprogesterone acetate, or DMPA, is the active ingredient in Depo-Provera and in other popular DMPA injectables including Depo Sub-Q Provera 104, Sayana Press, and a number of other brands.

DMPA injectables prevent pregnancy for three months. Studies have shown, however, that Depo-Provera can delay a return to fertility for much longer, up to 31 months.i

DMPA injectables are administered as an intramuscular or subcutaneous injection. DMPA consists of large doses of artificial steroids that prevent follicular maturation and ovulation. DMPA has been noted to maintain thick cervical mucus which prevents fertilization. DMPA also causes endometrial thinning which makes the uterine lining hostile to blastocyst implantation in the event that an egg does becomes fertilized.

What Is the Associated Risk of Acquiring HIV with DMPA?

A recent meta-analysis, Brind, et al. (2015), conducted in collaboration with the Population Research Institute, found that the associated risk of acquiring HIV with DMPA usage was significantly higher than for women who did not use DMPA based injectable contraceptives. DMPA was found to increase women’s risk of contracting HIV by 49% compared to women not using steriodal (hormonal) contraceptives (HR = 1.49, 95% CI 1.28-1.73). Over 88% of cross-sectional studies and over 75% of longitudinal studies observed a positive association between HIV acquisition and DMPA use.

These findings were confirmed in earlier, less precise studies comparing the risk of DMPA compared to the general population. Less precise non-prospective studies found that DMPA increased the risk of HIV transmission by over 40% (OR=1.41, 95% CI 1.15-1.73).

These findings are confirmed in two other meta-analyses published that were also published in 2015. Ralph, et al. (2015) in Lancet Infectious Diseasesfound a pooled hazard ratio of 1.40, 95% CI 1.16-1.69 among DMPA users. Morrison, et al. (2015) in PLoS Medicine also found similar results with an adjusted hazard ratio of 1.50, 95% CI 1.24-1.83 for DMPA. All three meta-analyses found that the risk of acquiring HIV with DMPA is 40-50% higher than the comparison group.

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