Modelling the global competing risks of a potential interaction between injectable hormonal contraception and HIV risk.
Ailsa R. Butler,Jennifer A. Smith,Chelsea B. Polis,Simon Gregson,David C. Stanton,Timothy B. Hallett +5 more
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If IHC use increases HIV acquisition risk, reducing IHC could reduce new HIV infections; however, this must be balanced against other important consequences, including unintended pregnancy, which impacts maternal and infant mortality.Abstract:
BACKGROUND: Some but not all observational studieshave suggested an increase in risk of HIV acquisition for women using injectable hormonal contraception (IHC). METHODS: We used country-level data to explore the effects of reducing IHC use on the number of HIV infections the number of live births and the resulting net consequenceson AIDS deaths and maternal mortality for each country. RESULTS: High IHC use coincides with high HIV incidence primarily in southern and eastern Africa. If IHC does increase the risk of HIV acquisition this could generate 27 000-130 000 infections per year globally 87-88% of which occur in this region. Reducing IHC use could result in fewer HIV infections but also a substantial increase in live births and maternal mortality in countries with high IHC use high birth rates and high maternal mortality: mainly southern and eastern Africa South-East Asia and Central and South America. For most countries the net impactof reducing IHC use on maternal and AIDS-related deaths is dependent on the magnitude of the assumed IHC-HIV interaction. CONCLUSIONS: If IHC use increases HIV acquisition risk reducing IHC could reduce new HIV infections; however this must be balanced against other important consequences including unintended pregnancy which impacts maternal and infant mortality. Unless the true effect size approaches a relative risk of 2.19 it is unlikely that reductions in IHC could result in public health benefit with the possible exception of those countries in southern Africa with the largest HIV epidemics.read more
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HIV infection: epidemiology, pathogenesis, treatment, and prevention
TL;DR: The role of immune activation in the pathogenesis of non-AIDS clinical events (major causes of morbidity and mortality in people on antiretroviral therapy) is receiving increased recognition and breakthroughs in the prevention of HIV important to public health include male medical circumcision.
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The Institutional Care of Children. United Nations Department of Economic and Social Affairs
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An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women.
Chelsea B. Polis,Kathryn M. Curtis,Philip C Hannaford,Sharon J. Phillips,Tsungai Chipato,James Kiarie,Daniel Westreich,Petrus S. Steyn +7 more
TL;DR: New information increases concerns about DMPA and HIV acquisition risk in women, and data for other hormonal contraceptive methods, including norethisterone enanthate, are largely reassuring.
Journal ArticleDOI
Contraceptive Practice in Sub-Saharan Africa.
TL;DR: Modern contraceptive practice in Sub-Saharan Africa is found to be on the rise overall but with much geographic variation, and the contraceptive methods most frequently used are injectables and, more recently, implants.
Journal ArticleDOI
Use of hormonal contraceptives and HIV acquisition in women: a systematic review of the epidemiological evidence
TL;DR: Some, but not all, observational data raise concern about a potential association between use of DMPA and risk of HIV acquisition, and more definitive evidence for the existence and size of any potential effect could inform appropriate counselling and policy responses in countries with varied profiles of HIV risk, maternal mortality, and access to contraceptive services.
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