Saturday, May 12, 2012

Questions from Africa About Safety of Injectable Depo Provera

Despite glib assurances from WHO and their collaborators that injectable Depo Provera and similar hormonal contraceptives are safe in high HIV prevalence African countries (they are not so much used in low HIV prevalence countries), some are not convinced. An article in The East African by Esther Nakkazi raises the question of whether it's safe to use injectables if you are also on antiretroviral drugs and feels that this has not yet been adequately answered.

WHO effectively contracdicted themselves by denying that injectable hormonal contraceptives increased the risk of HIV transmission from HIV positive men to HIV negative women and from HIV positive women to HIV negative men, despite several pieces of research suggesting otherwise. While the WHO may be right, they accepted that the issues involved are far from clear. The effective contradiction stems from categorical advice to continue using Depo Provera and the like while at the same time admitting that they really don't know yet because the appropriate research has not been carried out.

In the absence of clarity, it would be better to advise women that they could face a higher risk of being infected if they are negative and of infecting their partner if they are positive. There are alternatives to Depo, far cheaper alternatives, and some of these, such as condoms, protect against HIV and sexually transmitted diseases as well as preventing pregnancy. Where condoms and other methods are not an option, it seems unlikely that other precautions will be taken.

As for the use of antiretroviral drugs by HIV positive people to reduce transmission, many people in high prevalence countries don't know their HIV status and only about one third of those who are HIV positive are on ARVs. Many of those on ARVs may not even be adhering to their drug regime closely enough to keep their viral load down and others may already have developed resistance, or have been infected with a resistant strain of the virus.

People are calling for further research and greater clarity. Women (and their partners) have a right to the sort of information that WHO are saying is not available. If the information is not available, the use of Depo and similar drugs should be reconsidered, especially injectable Depo. Advising women to continue the practice, but also "to use condoms and other HIV preventive measures), even women thought to be at high risk of infecting others and those at high risk of being infected, is not good enough.

There seems to be a lot of value placed on continuing to sell pharmaceutical products in developing countries, using 'aid' money, of course, regardless of any possible consequences. The use of antiretroviral drugs to prevent transmission of HIV from mothers to their children has been highly successful, as has their use to keep HIV positive people alive for many years. But this should not result in the totally indiscriminate use of drugs in the name of public health.

It is sometimes argued that HIV positive women who become pregnant risk their child's health as well as their own. But HIV transmission will not be eliminated by a blanket birth control policy, which is an entirely separate matter. Women are entitled to adequate information about whether to use birth control, as well as what method of birth control to use. The threat of HIV infection for them, their partner or their children, should not be used to promote a Western population control agenda, particularly when one of the most aggressively marketed methods, injectable Depo Provera, has been associated with an increased risk of HIV infection.

[For more about non-sexual HIV transmission and injectable Depo Provera, see the Don't Get Stuck With HIV site.]


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