Hormonal contraception use and HIV infection in Mthatha
Date
2019
Authors
Ndebia, Eugene Jamot
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Hormonal contraception (HC) is used by over 150 million women worldwide with 100 million using oral contraception and 40 million using injectable contraception. Hence, the choice of a contraceptive method with lower human immunodeficiency virus (HIV) acquisition risk is a problem of concern for women. Many studies have been reported to clarify the effect of HC on HIV acquisition risk, but the results are still very controversial, inconsistent with conflicting findings among them. The objective of this study is to evaluate the risk of HIV acquisition when using HC in a rural setting of Mthatha in South Africa. Methods: This study was a cross-sectional study. HC and sexual behaviour risk information was obtained directly from participants by the administration of a structured questionnaire. Results of HIV testing was made available to the researcher after the counselling session. The prevalence of HIV was estimated using a single proportion method, the association between hormonal contraceptive use and HIV was assessed using logistic regression models. The presence of effect modification between covariates and HIV acquisition was measured by calculating the relative excess risk of interaction. Results: 501 women aged 18-45 years agreed to participate in the study. Among them 159 were HIV positive representing a prevalence of 32% (95% CI: 28% - 36%). After adjusting for confounders, women who used HC had higher odds of HIV infection compared to women who did not use HC (OR: 1.87, 95% CI: 1.08-3.23). The effect of HC on HIV was modified by age and marital status with a coefficient for interaction of 1.39 (95% CI: 1.13-1.71) and 1.22 (95% CI: 1.10-1.41) respectively.
Conclusion: In summary, we found that HC was associated with the risk of HIV acquisition in women coming for voluntary HIV screening in the rural setting of Mthatha. While further research is required, it is advised that contraceptive counselling should be included in HIV screening and counselling for optimisation of women sexual reproductive health and HIV prevention.
Description
A research report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Masters of Science in Epidemiology (Epidemiology and Biostatistics)
November 2019