Living with Uncertainty: Acting in the Best Interests of Women

Overview

Journal AIDS Res Treat

Publisher Wiley

Specialty Infectious Diseases

Date 2012 Nov 30

PMID 23193463

Citations 6

Authors

Erica Gollub

Zena Stein

Affiliations

Soon will be listed here.

Abstract

A recent multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives. Together with a prior cohort study on African women seeking health services, these data are the strongest yet to appear on the HC-HIV risk. This paper will briefly review the Heffron study strengths and relevant biological and epidemiologic evidence; address the futility of further trials; and propose instead an alternative framework for next steps. The weight of the evidence calls for a discontinuation of progestin-dominant methods. We propose here five types of productive activities: (1) scaling injectable hormones down and out of the contraceptive mix; (2) strengthening and introducing public health strategies with proven potential to reduce HIV spread; (3) providing maximal choice to reduce unplanned pregnancy, starting with quality sexuality education through to safe abortion access; (4) expanding provider training, end-user counseling and access to male and female barriers, with a special renewed focus on female condom; (5) initiating a serious research agenda to determine anti-STI/HIV potential of the contraceptive cervical cap. Trusting women to make informed choices is critical to achieve real progress in dual protection.

Citing Articles

The Need for Policy Change Regarding Progestin-Only Injectable Contraceptives.

Gollub E, Jones H, Ralph L, van de Wijgert J, Padian N, Stein Z J Womens Health (Larchmt). 2018; 28(9):1180-1184.

PMID: 30576259 PMC: 6909683. DOI: 10.1089/jwh.2018.7284.

Knowledge, attitudes, practices and behaviors associated with female condoms in developing countries: a scoping review.

Moore L, Beksinska M, Rumphs A, Festin M, Gollub E Open Access J Contracept. 2018; 6:125-142.

PMID: 29386930 PMC: 5683136. DOI: 10.2147/OAJC.S55041.

Knowledge, acceptance and utilisation of the female condom among women of reproductive age in Ghana.

Ananga M, Kugbey N, Akporlu J, Asante K Contracept Reprod Med. 2017; 2:15.

PMID: 29201420 PMC: 5683207. DOI: 10.1186/s40834-017-0042-9.

Active Drug-Using Women Use Female-Initiated Barrier Methods to Reduce HIV/STI Risk: Results from a Randomized Trial.

Gollub E, Cyrus-Cameron E, Armstrong K, Boney T, Mercer D, Fiore D ISRN Addict. 2015; 2013:768258.

PMID: 25938118 PMC: 4392969. DOI: 10.1155/2013/768258.

Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies.

Ralph L, McCoy S, Shiu K, Padian N Lancet Infect Dis. 2015; 15(2):181-9.

PMID: 25578825 PMC: 4526270. DOI: 10.1016/S1473-3099(14)71052-7.

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