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Oral and injectable contraception use and risk of HIV acquisition among women in sub-Saharan Africa

McCoy, Sandra I.a; Zheng, Wenjinga; Montgomery, Elizabeth T.b; Blanchard, Kellyc; van der Straten, Arianeb,d; de Bruyn, Guye; Padian, Nancy S.a,f

doi: 10.1097/QAD.0b013e32835da401
Epidemiology and Social

Objective: To evaluate the effect of oral and injectable hormonal contraception on the risk of HIV acquisition among women in South Africa and Zimbabwe.

Design: Secondary data analysis of 4913 sexually active women aged 18–49 years followed for up to 24 months in the Methods for Improving Reproductive Health in Africa (MIRA) phase III effectiveness trial of the diaphragm and lubricant gel for HIV prevention.

Methods: Participants were interviewed quarterly about contraception and sexual behavior and were tested for pregnancy, HIV, and other sexually transmitted infections. We used a Cox proportional hazards marginal structural model, weighted by the inverse probability of hormonal contraception use, to compare the risk of HIV acquisition among nonpregnant women reporting use of combined oral contraceptive pills (COC), progestin-only pills (POP), and/or injectable hormonal contraception to women not using these methods.

Results: During the study, 283 participants seroconverted. Use of oral contraceptives (POP or COC) was not associated with HIV risk [adjusted hazard ratio (HRa) = 0.86, 95% confidence interval (CI) 0.32, 1.78]. Injectable hormonal contraception was associated with a small nonsignificant risk of HIV infection (HRa = 1.34, 95% CI 0.75, 2.37). The effect of injectable hormonal contraception was similar in the unweighted site-adjusted only (HRa = 1.32, 95% CI 1.00, 1.74) and baseline factor adjusted models (HRa = 1.27, 95% CI 0.94, 1.72).

Conclusions: In this study, oral contraceptives were not associated with HIV acquisition. There is substantial uncertainty in the effect of injectable hormonal contraception on HIV risk. These findings underscore the importance of dual protection with condoms and the need for diverse contraceptive options for women at risk of HIV infection.

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aUniversity of California, Berkeley, California

bWomen's Global Health Imperative, RTI International, San Francisco, California

cIbis Reproductive Health, Cambridge, Massachusetts

dUniversity of California San Francisco, California, USA

eUniversity of the Witwatersrand, Johannesburg, South Africa

fUS Department of State, Washington, DC, USA.

Correspondence to Sandra I. McCoy, MPH, PhD, Assistant Adjunct Professor, Division of Epidemiology, School of Public Health, 1918 University Avenue, Suite 3B, University of California, Berkeley, CA 94704, USA. Tel: +1 510 642 0534; fax: +1 510 642 5018; e-mail:

Received 14 September, 2012

Revised 29 November, 2012

Accepted 6 December, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.