Assessing the Potential Impact of Hormonal-Based Contraceptives on HIV Transmission Dynamics Among Heterosexuals

Abstract

Background: HIV susceptibility linked to hormonal contraception (HC) has been studied before, but with mixed results. Recent findings have prompted the World Health Organisation (WHO), to encourage women who use HC to concurrently use condoms in order to prevent HIV infection in light of possible increased HIV risk of infection associated with hormone based contraceptives. Methods and Findings: A two sex HIV model classifying women into three risk groups consisting of individuals who use condoms, natural methods and hormone based contraceptives is formulated and analysed to assess the effects of various birth control methods on the transmission dynamics of the disease. Our model results showed that women who use HC could be key drivers of the epidemic and that their increased infectivity may be critical in driving the epidemic. Women who use hormone based contraceptives potentially act as a core-group from which men get infected and in turn transmit the disease to other population groups. We fitted the model to HIV prevalence data for Zimbabwe reported by UNAIDS and Zimbabwe Ministry of Health and Child welfare (MoHCW) and used the model fit to project HIV prevalence. Predictions using HIV data for Zimbabwe suggest that a hypothesised increase in susceptibility and infectivity of 2, 3, and 4 fold would result in a 25%, 50% and 100% increase in baseline HIV prevalence projection respectively, thus suggesting possible increased disease burden even in countries reporting plausible HIV prevalence declines. Conclusion:Although a possible causal relationship between HIV susceptibility and HC use remains subject of continuing scientific probe, its inclusion as part of birth control strategy, has been shown in this study, to possibly have significant influence on HIV transmission. If proven, HC use may potentially explain the inordinate spread of HIV within the sub-Saharan Africa region and therefore compel for urgent assessment with a view to reorienting birth control methods in use in settings with generalised epidemics.

HIV and contraceptive use in Zimbabwe amongst sexually active adolescent girls and women: Secondary analysis of Zimbabwe Demographic Health survey data

“…The country has a comprehensive family planning (FP) strategy which has seen a gradual increase in the uptake of modern methods of contraception over the past two decades [2]. However, evidence of integration of HIV education and family planning and maternal health services is generally lacking in the region including Zimbabwe [3][4][5]. This is despite the fact that integration of family planning and HIV education has been shown to be effective in preventing both HIV and unplanned pregnancies.…”

“…This is despite the fact that integration of family planning and HIV education has been shown to be effective in preventing both HIV and unplanned pregnancies. In the region, family planning and HIV visits are the only contacts women have with the health system and an opportunity to educate them on the prevention of both is lost [3]. Resultantly, higher incidence of unintended pregnancies in women living with the virus than in the general population have been reported [6].…”