Dear SuzyKnew!,

 I heard that there is a link between using “the shot” (injectable contraceptives) and HIV, is this true? What about other contraceptive methods?  I want to continue using injectables, but as a Black woman born in Africa living between the States and an African country with a high rate of HIV, what should I do?

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Dear Reader,

The World Health Organization (WHO) issued guidance in March 2017 on the use of progesterone-only injectables, including DMPA (brand name Depo-Provera) and NET-EN, stating that women who use this contraceptive method need to be informed that there may be an increased risk of acquiring HIV.  So yes, there is a link, but the reason this happens with some users is not yet clear to scientists.  There seems to be something going on with how the hormone in the injectables affects the cells in a woman’s genital tract and cervix, making her more vulnerable to HIV infection, if in fact she is exposed to HIV.

It appears that the link does not exist for other hormonal contraceptives, such as implants, hormonal IUD, or oral contraceptive pills.  Remember- the ONLY way to protect yourself from HIV is using a barrier method- male or female condoms.

Sistas’ need to know: Protect yourself from HIV and other STIs with a barrier method, no matter what contraceptive method you choose.

This news is significant because millions of women around the world depend on “the shot”,  “the jab”, Depo-Provera, or the Sayana Press in order to avoid getting pregnant.

Injectables are some of the most commonly used contraceptive methods in the world, and are heavily used by women in Sub-Saharan Africa, a region of the world that also has high rates of HIV.  Take Malawi, for example, where 10% of the population is HIV+ and 26% of women have an unmet need for contraception, meaning that they want to use birth control, but are unable.  In countries like Malawi, injectables play a major role in meeting the needs of women, with 32% of the women making injectables their method of choice. The University of California at Berkeley analyzed 12 studies from sub-Saharan Africa covering nearly 40,000 women which showed increased HIV risk but no similar risk increase with oral contraceptive pills.

Injectable contraceptives also play an important role in the contraceptive mix in among women of color in the U.S. where there is a relatively high prevalence of HIV.  According to the Centers of Disease Control (CDC), although the pill is the most common form of contraception for U.S. women, 27% of Latina women and 34% of African-American women have used Depo-Provera, or “the shot” compared to 20% of white women and 10% of Asian women.  And, while HIV rates have fallen recently among Black women, we are the most affected by HIV in heterosexual communities. Because injectables are 99% effective, low cost, and need to be taken only once every three months they are the method of choice for millions of women.

If you want to continue using DMPA or NET-EN, know that there is some increased risk for HIV compared to other contraceptive methods. 

Health leaders are currently developing messages (due to come out in April 2017) for health care providers and community leaders so that they can educate women and men about the potential risks of HIV and use of injectables.  Please check back with us at SuzyKnew! if you have any questions when these messages come out.

Take care.

ASK AN OBGYN is not meant to replace consulting your ob/gyn or primary care provider. Ask your questions at obgyn@suzyknew.com