This month and last, the World Health Organization (WHO) convened two meetings of public health experts and citizens from some of the countries of the world most affected by HIV/AIDS. Participants were asked to review a new study suggesting that hormonal contraception increases women's risk of transmitting HIV to their partners and determine whether the WHO should revise its guidance for HIV-positive women. The results are in -- and it's a resounding no.
The panel found there was not enough evidence to recommend that HIV-positive women abandon hormonal methods of contraception. Soon thereafter, the WHO announced that there would be no change in official guidance, which includes no restrictions on hormonal contraception for HIV-positive women to prevent unintended pregnancy.
This study in question appeared this past November in the Lancet, a medical journal, and caused quite a stir among those of us working in the field of reproductive health and HIV prevention. Experts around the world immediately raised concerns about this new study. The findings contradicted the majority of previous research on the same topic, including a dozen prior studies. The International Planned Parenthood Federation and the United States Agency for International Development (USAID) immediately issued statements advising health professionals around the world not to limit women's access to lifesaving contraceptive methods before all the facts were in.
More than anything, what the brouhaha around this flawed study underscores is the importance of dual protection for couples who wish to avoid unintended pregnancy and prevent HIV transmission. According to Guttmacher, "women in sub-Saharan Africa not only face the world's highest risk of maternal death, but also the highest risk of HIV infection. Voluntary contraception is crucial for women who have or are at risk of HIV because it helps prevent unintended pregnancy and its health risks."
Male and female condoms are the only methods currently available that protect against both. Women simply need more options. As Michael Sidibé, executive director of UNAIDS put it in a statement on the WHO decision:
"Women need safe contraceptive and HIV prevention options that they can own and manage. New investments into research for female controlled HIV prevention options and safe contraceptive methods are essential."
Globally, about half of people living with HIV are women, and women account for more than half of new infections. This epidemic disproportionately affects women of color and poor women. Why? Because women of color and poor women lack sufficient access to methods of prevention. Too often, women must rely on men's condom use to protect them. Too often men's condom use is inconsistent.
This is as true in the U.S. as it is overseas. African-American women also have disproportionately high rates of HIV/AIDs and other sexually transmitted infections. Though African Americans represent 14 percent of the population, we account for 69 percent of gonorrhea cases and about half of all cases of HIV/AIDS, chlamydia, and syphilis.
Women need research, not restrictions. Donors, governments, and the pharmaceutical industry should invest in better technologies to increase the number of options on the market. Women in this country and around the world need convenient, affordable access to methods that empower them to prevent unintended pregnancy and HIV.
Clarification: The original opening line of this post "It was another victory for women's health" was added by an editor at Black Voices and is not the tone Planned Parenthood Federation of America would have cast on the news. The opening line has been removed. The Lancet study referenced in the original post was published online in October, not November. While the study described in this post was the main impetus for the World Health Organization (WHO) review, the meetings focused not just on this particular study but on all known evidence on the topic of hormonal contraception and HIV-positive women.
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