Contraception - Chemical Methods / Hormonal Contraception / Emergency / Morning After Pill

Depo Provera May Triple STD Risk (9/04)

Depo Provera Increases Chance of Chlamydia, Gonorrhea

Women who use the injected contraceptive Depo-Provera have a higher rate of sexually transmitted diseases, U.S. researchers [National Institutes of Health, UNC, and Johns Hopkins Univ in Baltimore] reported. This holds true even when behavior and other factors are taken into account.

It is possible that Depo-Provera itself causes a susceptibility to STDs [Charles Morrison of Family Health Int’l in Research Triangle Park, N.C., who led the study]"We did adjust for differences in condom use, differences in multiple partners, differences in the number of sexual coital acts," Morrison said. Inner-city and younger women also had a higher risk of STDs, but using Depo-Provera added to the risk, the study found.

Morrison said the researchers were especially concerned because Depo-Provera or its generic equivalent are being increasingly used in Africa, where STDs such as the AIDS virus are very common. He said women who use Depo-Provera to prevent pregnancy should take extra care if they are in relationships in which either they or their partner have sex with other people.

Like birth control pills, Depo-Provera provides no protection from an infection such as syphilis, gonorrhea or the AIDS virus.

"For sexually active women not in a mutually monogamous relationship, limiting the number of partners may also help to reduce the risk," Morrison added.

The researchers studied about 800 women age 15 to 45 using two clinics in the Baltimore area — one urban, serving mostly black women, and one suburban with a client base of white, college-age women. Most were single.

 

The women chose whether they wanted to use Depo-Provera, contraceptive pills, or a non-hormonal contraceptive method.

After a year, 45 women had become infected with chlamydia or gonorrhea.

The women using the injected contraceptive were three times as likely to have one of the STDs, the researchers said.
 

Because there were different numbers of women in each group, the researchers calculated risk of infection by "women-years" — how many women became infected in the space of a year.

The risk for women taking oral contraceptives was 3.9 infections per 100 women-years, 13.7 infections per 100 women-years in the Depo-Provera6 infections per 100 women-years in the women using condoms, diaphragms or other non-drug birth control methods.

Morrison said although it appeared from looking at the bare numbers that the pill group had the lowest risk, in fact when other factors were considered, their [the pill group] risk of STDs was about the same as the women who did not use hormonal contraception.

Depo-Provera is made by Pfizer Inc. and last month Israel's Teva Pharmaceutical Industries Ltd. won U.S. approval for a generic version [Reuters].

[Comments: This is actually the second time contraception promoters — who dismiss chastity supporters as "unrealistic" and even "dangerous" — have found that artificial contraceptives have led to more STDs. In the 1990s, nonoxynol-9, a spermicide that was also widely used in condoms, was given to African prostitutes as part of an AIDS study and researchers were surprised when this actually increased the chances of getting AIDS. Not surprising, since the drug often causes vaginal irritation and thus makes it easier to contract an infection.

(See "AIDS Study Prompts New Look at Prevention Nonoxynol 9", online at:
http://www.hivnet.ch:8000/global/media-aids/viewR?56)
  

In addition and despite this article's defense of the birth control Pill, there is evidence that even the Pill may increase STDs, especially if it causes vaginal thinning. (See: "Do Hormonals Affect STI Risks?", online at:
http://www.reproline.jhu.edu/english/6read/6issues/6network/v20-4/nt2047.html)
 

All of this is not good news for Planned Parenthood and other groups promoting abortion and contraception whose support of "sexual freedom" is based on the alleged ability of technology to prevent pregnancy and disease.
[N Valko RN]  [http://www.msnbc.msn.com/id/5796331/ Sept. 1, 2004 WASHINGTON; September 04 issue journal Sexually Transmitted Diseases]

 

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The headlines were surprising, although the news was not:
USA Today: "Contraceptive is linked to high STD risk" (1)

MSNBC/Reuters: "Contraceptive may triple STD risk; Study: Depo Provera increases chance of chlamydia, gonorrhea" (2)

WebMD: "Depo Provera May Raise STD Risks: Injectable Contraceptive Linked to Higher Chlamydia and Gonorrhea Risk" (3)

The stories were based on a study published in the September issue of "The Journal of the American Sexually Transmitted Disease Association" (4), reported in press releases from Family Health International, (5) and the National Institutes of Health (NIH).

 

According to the NIH, the study found:

"The injectable contraceptive depot-medroxyprogesterone acetate (DMPA) appears to increase a woman's risk of acquiring the sexually transmitted infections chlamydia and gonorrhea by approximately three fold when compared to women not using a hormonal contraceptive, according to a study jointly funded by the National Institute of Child Health and Human Development (NICHD)

at the National Institutes of Health and the U.S. Agency for International Development's Office of Population and Reproductive Health." (6)

Depo-Provera is the name under which DMPA is marketed. Injected into the arm or buttocks four times a year, the drug works by inhibiting ovulation and, when breakthrough ovulation and conception occurs, implantation.

Why does Depo-Provera increase the risk of STDs? "The study was unable to identify the means by which DMPA might increase the risk for chlamydial or gonococcal infection,"(7) according to Joanne Luoto, M.D., of NICHD's Contraception and Reproductive Health Branch.

But surely this is no mystery. For some time it has been suspected that use of any progesterone-based approach to contraception, from Norplant and Depo-Provera, to various kinds of birth control pills, increases the risk of contracting STDs, including deadly HIV/AIDS virus.

A 1996 study conducted by researchers at the Aaron Diamond AIDS Research Center in New York and supported by the World Health Organization found an elevated HIV infection rate among monkeys who were given subdermal progesterone implants. The study also found that the vaginal epithelia-the lining of the vagina–of the monkeys with the implants were "significantly reduced."

The Aaron Diamond Study confirms that the presence of progesterone thins the vaginal wall, thus making it far more vulnerable to abrasions and infection by STDs or HIV during intercourse.

This new research has sobering implications for the AIDS epidemic in Africa and our role in it. The U.S. foreign aid establishment would sooner eat ground glass than admit it, but it is very likely that our family planning programs have been aiding the spread of the HIV virus.

From 1994-2000, USAID provided 41,967,200 units of Depo-Provera into the developing world, at a cost of over $40 million.(8) An even larger source of Depo-Provera is the UNFPA, which boasts of being the largest supplier of contraceptives in the world. In the nineties, when it was receiving funding from the Clinton administration, the UNFPA was shipping 20 million doses of Depo Provera out the door a year.(9)

The lion's share of these shipments was and is bound for Africa. Depo-Provera is a major component of foreign-funded family planning programs in Africa. USAID sends more units of Depo-Provera to Africa, to countries such as Mozambique, Tanzania and Nigeria, than to any other part of the world.

Although the UNFPA is less transparent about the destination of its contraceptive shipments, it does admit to spending more money on its African programs than elsewhere. Once in Africa, the Depo-Provera is handed out under "social marketing" schemes to virtually any woman who will agree to take it. Women are expected to inject themselves with the drug, and are given no medical advice or counseling whatsoever.

The bottom line? As the HIV/AIDS epidemic in Africa rages out of control, we have been recklessly promoting and distributing drugs which make women even more vulnerable to the deadly virus. We have been pouring gasoline on a fire. ["Depo Provera Hazardous to Health",
SEP 08, 2004, Abstinence Clearinghouse]

ENDNOTES:

1. USA Today; 8/22/04; http://www.usatoday.com/news/health/2004-08-22-std-risk_x.htm

2. MSNBC/Reuters; 8/23/04; http://msnbc.msn.com/id/5796331

3.WebMD; http://webcenter.health.webmd.netscape.com/content/article/93/102115.htm

4. The Journal of the American Sexually Transmitted Disease Association, September 2004; http://www.stdjournal.com

5. Family Health International; "Depo Provera Appears to Increase Risk for Chlamydial and Gonococcal Infections;" 8/23/04 http://www.fhi.org/en/AboutFHI/News+Releases/Aug232004DepoChlamGonocc.htm

6. NIH Press Release; "Depo Provera Appears to Increase Risk for Chlamydial and Gonococcal Infections;" http://www.nih.gov/news/pr/aug2004/nichd-23.htm

7. ibid.

8. Numbers are from the Population, Health and Nutrition Projects Database> > (PPD), http://ppd.phnip.com. PPD is a computer-based information system managed by the Population, Health, and Nutrition Information Project on behalf of USAID's Center for Population, Health and Nutrition. See also PRI Review, January-February 2003, 13(1), 5.

9."New Era for Injectables," Population Reports, 23(2), August 1995. Like most UN agencies, the UNFPA is extremely secretive about its operations. According to Population Reports, DMPA (Depo-Provera, Megastron) makes up three-quarters of UNFPA shipments of injectables, and NET EN (another injectable contraceptive) one-quarter. Thus in 1994 UNFPA shipped enough injectables for about 4.6 million woman-years of use. Deliveries of DMPA by the International Planned Parenthood Federation increased from 336,000 doses in 1991 to 735,000 in 1994. Deliveries of NET EN increased from 305,000 in 1991 to 438,000 in 1994. It is unclear whether the UNFPA, International Planned Parenthood Federation (IPPF), or other suppliers ship only single-dose vials, with an equal number of syringes and needles, or whether they sometimes provide the drug to end-users as multi-dose vials, with the associated risk of contamination and HIV transmission that reusing the vials entails.