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The most commonly used contraceptive method in South Africa may be related to increased vulnerability to AIDS infection, and health professionals are disoriented and do not know how to act. In a country where more than 22% of women between ages of 15 and 49 are HIV-positive, this potential connection is a source of concern among professionals. The injectable contraceptive, which lasts three months, is marketed under name Depo-Provera (DMPA) and is supplied free of charge by South African Government.
The latest demographic and health survey showed that 17.7% of country's women use it. If re is a causal relationship between Depo-Provera and increased vulnerability to AIDS, se figures would mean that millions of women are at risk. However, this has not yet been demonstrated irrebatibly.
A recent study by Population Research Institute has concluded that, compared to women who do not use hormonal contraceptives, DMPA increases risk of getting AIDS by 49%. In contrast, or studies do not show this same increase.
The discrepancy between results has caused confusion among health professionals and, in December 2016, World Health Organization (WHO) advisory group, made up of scientists and researchers from around world, reviewed 13 observational studies that point to potential danger that vulnerability to AIDS will be greater when used.
Its guidance note, made public this year, expresses its concern and recommends that women be informed that y may be at greater risk. However, he did not propose withdrawal of drug.
"For many women, Depo-Provera has been a gift from heaven"
In South Africa, medical professionals explain popularity of Depo-Provera for its ease of use. It is much more comfortable than taking a pill every day, you do not have to go to doctor so often, and you do not need to have reservations at home.
Observational data available at this time suggest that Depo-Provera carries a higher risk compared to or hormonal methods
"For many women it has been a gift from heaven," says Marion Stevens, president of Coalition for Sexual and Reproductive Justice, "but problem is that [in South Africa] re is no official position on what information give on possible risks ".
The National Clinical Guidelines of South Africa on Contraception indicate that advantages of injectable drug to prevent pregnancy "should be assessed against risks of contracting AIDS," but do not specify what a doctor has to say to his patient when this one asks Depo-Provera. If women can not use it, or alternatives are an effective injectable for two months, pill, or contraceptive implants, but not all of m can be found in any establishment.
Helen Rees, executive director of Wits Institute for Reproductive Health and HIV, says first observational studies on AIDS and quarterly injectable drug in late 2000s yielded conflicting results.
He explained that some concluded that risk was greater, and ors who did not, and that "re were also problems with methodology." He adds that his object of study was anor - like efficacy of various microbicides - and not exclusively Depo-Provera.
In addition, y failed to make distinctions based on all variables, such as wher participants switched to anor contraceptive method during test. Since n, a number of better-designed studies have been conducted and, according to Rees, "observational data available at this time seem to indicate that Depo-Provera carries a higher risk compared to or hormonal methods."
At a minimum, information must be provided to women so that y can give ir informed consent
Scientists are currently trying to find a definitive answer to question of wher y expose women to a higher risk of getting AIDS and why. The Evidence on Contraceptive Options and its Impact on AIDS (ECHO) is first randomized trial to examine three contraceptive methods and ir effects on HIV vulnerability. The study, which is being carried out in 12 locations in four countries (Kenya, South Africa, Swaziland and Zimbabwe), investigates effects of Depo-Provera, Jadelle - an effective implant for two years - and intrauterine devices (IUDs) whose action is not based on hormones.
"The participants are women who are not carriers of AIDS virus, sexually active, who are looking for a contraceptive method and have no problem in joining one of se three," explains Rees. They are all advised to make it clear that y have understood purpose of study and advantages and risks of each method. They are asked to continue using it for a minimum of 12 months and a maximum of 18 months.
The first results of ECHO study will not be published until late 2018 or early 2019. Until n, in South Africa women will be able to continue to opt for Depo-Provera in ir local health centers. Given number of South Africans who preferentially use it, withdrawing it while conducting research could expose many of m to unwanted pregnancies. Until findings are made public, re is no evidence that a Depo-Provera injection increases a woman's risk of contracting HIV, but observational studies warrant concern.
This puts doctors in a compromised situation. According to Tlaleng Mofokeng, a reproductive rights activist, crux of matter is that women must have access to best and most recent information on contraceptives and be able to use option of ir choice. "At a minimum, y must be given information so that y can give ir informed consent."
That is why, like 2017 World Health Organization guidance note, Mofokeng believes that women should be advised of possible relationship between Depo-Provera and AIDS even before results of ECHO study.
This article was originally published in English on NewsDeeply.