By CHRISTINE MWAABA

A major clinical trial conducted in four African countries has
found no significant risk of HIV infection among women using hormonal
contraceptives and the copper non-hormonal intrauterine device (IUD).

Over the past thirty years, there had been studies that suggested
there could be a link between the commonly used three-month
contraceptive shot, known as Depo Provera and HIV risk.

But there were also studies that showed no risk. Only a clinical trial
could solve the riddle.

The ECHO study set out to find out. Almost 8000 women who were
sexually active, but did not want to fall pregnant, were randomly
assigned one of three contraceptive methods: Depo-Provera (commonly
knows and Dep) or an upper-arm implant (also hormone based) or a
copper device inserted into the uterus. The study sites were in
Zambia, South Africa, Eswatini and Kenya.

The ECHO trial found no significant difference in the rates of HIV
infection among the three groups.

The study also showed that each method had high levels of safety and
effectiveness in preventing pregnancy.

In 2017, the World Health Organisation (WHO) had issued a guideline
that health providers should caution women that Depo Provera might
increase risk of HIV contraction among women.Depo-Provera is given as
an injection every three months.

Depo-Provera is a well-known brand name for medroxyprogesterone
acetate, a contraceptive injection for women that contains the hormone
progestin.

Depo-Provera is given as an injection every three months. Depo-Provera
typically suppresses ovulation keeping ovaries from releasing an egg
and it is the most widely used injectable contraceptive.

Further research published in the journal The Lancet Infectious
Diseases in 2015 found that women using the injections for
contraception were forty percent more likely to get HIV.

This fueled some myths around contraceptives and some years ago,
Zambian women believed Depo Provera had HIV contents.

The 2018 Zambia Health Demographic study shows that the majority of
married and unmarried women in reproductive age who use
contraceptives mainly use injectables followed by the pill and implants
and the male condom.

Now the ECHO (Evidence for Contraceptive Options and HIV Outcomes)
study has finally offered the answer to the myth around contraceptives
and put an end to the controversy that contraceptives increased the
chances of contracting HIV.

The randomized clinical trial was conducted by a research consortium
led by FHI 360 the University of Washington Wits Reproductive Health
and HIV Institute and the World Health Organisation.
Wits Reproductive Health and HIV Institute (Wits RHI) Executive
Director Helen Rees said it is undoubtedly a sense of relief at these
results, because the three-month injection is often one of the
only contraception options for women across sub-Saharan Africa.
She said among the 7,829 women who took part in the study, there was
no significant difference in the rate of acquisition of HIV.
It was noted that the rate of HIV infection was higher for women aged
less than 25 years irrespective of the method of contraceptive ,which
reinforces the need to integrate family planning and HIV services for
women.

During the trial participants were provided with condoms, counselling
on how to avoid contracting HIV, and treatment for sexually
transmitted infections. About 600 women took the once-a-day pill for
HIV prevention, known as pre-exposure prophlaxis PrEP..

Results were announced at the 9th South Africa (SA) AIDS conference
last week, with researchers making sure they were released at an
African event to honour the participants.

Treatment Advocacy and Literacy Campaign (TALC) National Co-ordinator
Felix Mwanza said ECHO has solved all outstanding questions about
contraceptives and showed that they do not increase the risk of
contracting HIV among women.

Mr Mwanza said it is important for women to understand that when they
have unprotected sex and use contraceptives, they should realise they
also need to use protection against HIV and sexually transmitted
infections.

PrEP was made available in the study, but only a few women used it.
For HIV advocates, the ECHO study showed a glimpse into many issues
that need to be addressed.

Women need to be more aware of their HIV risk and PrEP should be fully
utilised as a prevention tool.

The World Health Organisation (WHO) representative Dr Rachel Baggaley
said the study highlights the need to step up HIV prevention efforts
in these high-burden countries, particularly for young women.

This should include providing HIV testing and a range of HIV
prevention choices within contraceptive service programmes.

The Executive Director of the AIDS Vaccine Advocacy Coalition (AVAC)
said there was good news and bad news.

The trial had shown that the injectables were safe. On the other hand,
it delivered a sobering reminder that women and girls in East and
Southern Africa are still at very high risk of HIV infection.

Overall, almost four percent of the women became HIV infected during
the trial period.

While we know this had nothing to do with the contraceptives, it
points to very high HIV risk, in general, for women in Southern and
East Africa.

A member of the Global Community Advisory Group (GCAG) for the ECHO
study Yvette Raphael said women needed more options for contraception
combined with HIV protection.

“Regardless of the data from the ECHO trial, the limited choice of
contraceptives that women have is not OK. We hope that this result
will prompt action and put women first. Women want more options,” she
said.