ArticleContraception2015
Hormonal contraception does not increase women's HIV acquisition risk in Zambian discordant couples, 1994-2012.
Article in Contraception, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Hormonal contraception and HIV acquisition among women: an updated systematic review.BMJ sexual & reproductive health · 2020Pooled it
- An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women.AIDS (London, England) · 2016Pooled it
- Genital Abnormalities, Hormonal Contraception, and Human Immunodeficiency Virus Transmission Risk in Rwandan Serodifferent Couples.The Journal of infectious diseases · 2021Article
- Motivational interviewing to promote long-acting reversible contraception among Rwandan couples wishing to prevent or delay pregnancy.American journal of obstetrics and gynecology · 2020Article
- Sociodemographic factors and STIs associated withInternational journal of STD & AIDS · 2020Article
- Hormonal Contraception and Vaginal Infections Among Couples Who Are Human Immunodeficiency Virus Serodiscordant in Lusaka, Zambia.Obstetrics and gynecology · 2019Article
- Does bacterial vaginosis modify the effect of hormonal contraception on HIV seroconversion.AIDS (London, England) · 2019Article
- Effects of three long-acting reversible contraceptive methods on HIV target cells in the human uterine cervix and peripheral blood.Reproductive biology and endocrinology : RB&E · 2019Article
- Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition.AIDS (London, England) · 2018Article
- Article
- Depot medroxyprogesterone acetate administration alters immune markers for HIV preference and increases susceptibility of peripheral CD4ImmunoHorizons · 2017Article
- HIV Incidence and Predictors of HIV Acquisition From an Outside Partner in Serodiscordant Couples in Lusaka, Zambia.Journal of acquired immune deficiency syndromes (1999) · 2017Article
- Optimizing Prevention of HIV and Unplanned Pregnancy in Discordant African Couples.Journal of women's health (2002) · 2017Article
- Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples.Sexually transmitted infections · 2017Article
- Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?Contraception · 2017Article
- Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries.Epidemiology (Cambridge, Mass.) · 2017Article
- Levonorgestrel in contraceptives and multipurpose prevention technologies: does this progestin increase HIV risk or interact with antiretrovirals?AIDS (London, England) · 2016Article
- Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012.The Journal of infectious diseases · 2016Article
- Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women.Journal of acquired immune deficiency syndromes (1999) · 2016Article
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Authors and funding
10 authors at 5 institutions in 3 countries.
Funding
Abstract
objectiveTo determine the impact of hormonal contraceptive methods on risk of HIV acquisition among HIV-negative women cohabiting with HIV-positive male partners. STUDY
designFrom 1994-2012, HIV discordant couples recruited from a couples' voluntary HIV counseling and testing center in Lusaka, Zambia were followed longitudinally. HIV-negative partners were tested quarterly. This analysis is restricted to couples in which the man was HIV-positive and the woman was HIV-negative at enrollment and the man was not on antiretroviral treatment. Multivariate Cox models evaluated associations between time-varying contraceptive methods and HIV acquisition among women. Sensitivity analyses explored exposure misclassification and time-varying confounder mediation.
resultsAmong 1393 couples, 252 incident infections occurred in women over 2842 couple-years (8.9 infections per 100 couple-years; 95% CI, 7.8-10.0). Multivariate Cox models indicated that neither injectable [adjusted hazard ratio (aHR)=1.2; 95% CI, 0.8-1.7], oral contraceptive pill (OCP, aHR=1.3; 95% CI, 0.9-1.8), or implant (aHR=1.1; 95% CI, 0.5-2.2) use was significantly associated with HIV acquisition relative to non-hormonal contraception controlling for woman's age, literacy and time-varying measures of genital ulceration/inflammation. This remained true when only looking at the subset of infections acquired from the spouse (82% of infections) and additionally controlling for baseline HIV viral load of the male partner, pregnancy status, and time-varying measures of sperm on a vaginal swab wet prep and self-reported unprotected sex. OCP and injectable users reported more unprotected sex (p<.001), and OCP users were more likely to have sperm on vaginal swab (p=.1) than nonhormonal method users.
conclusionsWe found no association between hormonal contraception and HIV acquisition risk in women. Condom use and reinforced condom counseling should always be recommended for HIV discordant couples. HIV testing of sex partners together is critical to establish HIV risk, ascertain couple fertility intentions and counsel appropriately. IMPLICATIONS: These findings add to a controversial literature and uniquely address several common design and analytic challenges faced by previous studies. After controlling for confounders, we found no association between hormonal contraception and HIV acquisition risk in women. We support promoting condoms for HIV prevention and increasing the contraceptive method mix to decrease unintended pregnancy.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.