Study Disputes Link Between HIV and Depo Provera; African Women Insist Results are “Not Good News”

By | June 21, 2019

WASHINGTON, D.C. June 21 (C-Fam) For decades, an international debate has raged over whether the use of the injectable contraceptive Depo Provera increases women’s risk of contracting HIV when exposed to the virus. Last week, a landmark study released findings indicating that the risk is not significantly higher than for women using other contraceptive methods, including the non-hormonal copper intrauterine device (IUD).

The results were nevertheless troubling, as overall HIV acquisition in all study groups was higher than expected, and sexually transmitted diseases (STIs) were “common” among participants. Concerns also remain about other debilitating and life-threatening side effects of the drug, including irreversible bone density loss, bleeding, blood clots, and loss of vision.

Some African women leaders expressed concern that this study might be used to justify further efforts to expand use of Depo, despite these harmful effects. Depo is the default contraceptive promoted by the Bill and Melinda Gates Foundation, USAID, and other international aid agencies in developing countries, especially in Africa where alternative methods are less available. In recent years, the ethics of wealthy donors promoting this powerful injectable contraceptive with undesirable side effects in the developing world has been called into question often in international debates.

“We’ve heard scientists saying women love Depo; it’s not true,” said Yvette Raphael at an AIDS conference in Durban last week.

“Depo is not our favorite method!” she added as the audience applauded enthusiastically.

Raphael works on HIV/AIDS advocacy for women in South Africa. She is a member of the community advisory group for the project, known as the ECHO study.

When the results were announced at the AIDS conference, she welcomed the researchers’ findings, but insisted that “for us as women, these results are not good news.” Citing the high rate of HIV infection, she reminded the audience that “the women in the trial are our sisters and our mothers and our daughters.”

Raphael also decried the way in which Depo has come to “dominate women’s choices and programs in east and southern Africa.”

The study results were published in The Lancet, and a summary statement characterized all the contraceptive methods tested as “safe and highly effective (at preventing pregnancy).”

This new evidence against a link between Depo and HIV infection will reassure those administering international family planning programs that rely heavily on Depo. But it does not mean the drug has a clean bill of health.

The U.S. Food and Drug administration continues to apply a “black box” warning label to the drug due to its link with bone density loss, particularly among adolescent girls or women using it for more than two years. It also warns of the drug’s other debilitating side effects.

The World Health Organization (WHO) had previously revised its guidance on the use of Depo, after intense pressure from women’s health activists.  While the WHO guidelines insisted that the benefits of Depo outweighed the risks, they encouraged counseling for women at high risk of HIV acquisition.

Following the results of the ECHO study, WHO will convene a meeting next month to review all the available evidence, with a new guidance expected by the end of August. The study is likely to be cited against the previous counselling requirement.