[Ed. Note: Knowledge of the HIV – Hormonal Birth Control Link has been known for decades by birth control and abortion leaders. Only as the weight of these studies becomes unbearable, is the information finally seeping to the general public.]
Contraceptive Used in Africa May Double Risk of HIV
Comment: While contraceptives are sold to women as a benefit and right, terrible unexpected consequences continue to be discovered.
In contrast, Natural Family Planning is safe, inexpensive and effective for both achieving and postponing pregnancy. Practiced responsibly, the benefits of NFP include enhancing the marital bond, fostering understanding of the gift of fertility, giving the woman more knowledge and respect for her own body, and protecting her body from chemical pollution.
More and more couples are beginning to recognize that the current contraceptive mentality is not physically, emotionally or spiritually healthy. N Valko RN
Contraceptive Used in Africa — Depo-Provera — May Double Risk of H.I.V.
By PAM BELLUCK, NY Times
The most popular contraceptive for women in eastern and southern Africa, a hormone shot given every three months, appears to double the risk the women will become infected with H.I.V., according to a large study published Monday.
And when it is used by H.I.V.-positive women, their male partners are twice as likely to become infected than if the women had used no contraception.
The findings potentially present an alarming quandary for women in Africa. Hundreds of thousands of them suffer injuries, bleeding, infections and even death in childbirth from unintended pregnancies. Finding affordable and convenient contraceptives is a pressing goal for international health authorities.[see note below]
[Ed. Note: The MAJOR problem is NOT unintended pregnancies, but substandard prenatal care and poor obstetric support. Finding contraceptives is certainly NOT a problem, since they flood local clinics with them. And most African women do not find themselves in "an alarming quandary". They love children and really want emotional support and basic medical help to carry, deliver, and raise these children, their heritage.]
But many countries where pregnancy rates are highest are also ravaged by H.I.V., the virus that causes AIDS. So the evidence suggesting that the injectable contraceptive has biological properties that may make women and men more vulnerable to H.I.V. infection is particularly troubling.
[Ed. Note: Actually, studies for at least a decade have shown that hormonal contraceptives increase the risk of HIV transmission.]
Injectable hormones are very popular. About 12 million women between the ages of 15 and 49 in sub-Saharan Africa, roughly 6 percent of all women in that age group, use them. In the United States, it is 1.2 million, or 3 percent of women using contraception. While the study involved only African women, scientists said biological effects would probably be the same for all women. But they emphasized that concern was greatest in Africa because the risk of H.I.V. transmission from heterosexual sex was so much higher there than elsewhere.
“The best contraception today is injectable hormonal contraception because you don’t need a doctor, it’s long-lasting, it enables women to control timing and spacing of birth without a lot of fuss and travel,” said Isobel Coleman, director of the women and foreign policy program at the Council on Foreign Relations. “If it is now proven that these contraceptives are helping spread the AIDS epidemic, we have a major health crisis on our hands.”
The study, which several experts said added significant heft to previous research while still having some limitations, has prompted the World Health Organization to convene a meeting in January  to consider if evidence is now strong enough to advise women that the method may increase their risk of getting or transmitting H.I.V.
[Ed. Note: Meanwhile, they are NOT stopping distribution of the contraceptives! Read on…]
“We are going to be re-evaluating W.H.O.’s clinical recommendations on contraceptive use,” said Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s department of reproductive health and research. Before the meeting, scientists will review research concerning hormonal contraceptives and women’s risk of acquiring H.I.V., transmitting it to men, and the possibility (not examined in the new study) that hormonal contraceptives accelerate H.I.V.’s severity in infected women.
“We want to make sure that we warn when there is a real need to warn, but at the same time we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women,” she said. “This is a very difficult dilemma.” [emphasis added]
The study, led by researchers at the University of Washington and published in The Lancet Infectious Diseases, involved 3,800 couples in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the woman was already infected with H.I.V. Researchers followed most couples for two years, had them report their contraception methods, and tracked whether the uninfected partner contracted H.I.V. from the infected partner, said Dr. Jared Baeten, an author and an epidemiologist and infectious disease specialist.
The research was presented at an international AIDS conference this summer, but has now gained traction, scientists said, with publication in a major peer-reviewed journal.
The manufacturer of the branded version of the injectable, Depo-Provera, is Pfizer, which declined to comment on the study, saying officials had not yet read it. The study’s authors said the injectables used by the African women were probably generic versions.
The study found that women using hormonal contraception became infected at a rate of 6.61 per 100 person-years, compared with 3.78 for those not using that method. Transmission of H.I.V. to men occurred at a rate of 2.61 per 100 person-years for women using hormonal contraception compared with 1.51 for those who did not.
While at least two other rigorous studies have found that injectable contraceptives increase the risk of women’s acquiring H.I.V., the new research has some strengths over previous work, said Charles Morrison, senior director of clinical sciences
at FHI 360, a nonprofit organization whose work includes researching the intersection of family planning and H.I.V.
Those strengths include the fact that researchers followed couples and were therefore able to track transmission of H.I.V. to both men and women. Dr. Morrison said only one other less rigorous study had looked at whether hormonal contraception increased the risk of infected women’s transmitting the virus to men.
“This is a good study, and I think it does add some important evidence,” said Dr. Morrison, who wrote a commentary accompanying the Lancet article.
Although the study has limitations, including its use of data not originally intended to determine the link between contraceptive use and H.I.V., “I think this does raise the suspicion” that injectable contraceptives could increase transmission risk, he said.
Why that would occur is unclear. The researchers recorded condom use, essentially excluding the possibility that increased infection occurred because couples using contraceptives were less likely to use condoms.
The progestin in injectable contraceptives appears to have a physiological effect, scientists said.
Renee Heffron, an epidemiologist and co-author of the study, said research examining whether the hormone changes genital tissue or vaginal mucous had been inconclusive. Studies in macaques found that progestin thins vaginal tissue, she said, “but studies among women didn’t show the same amount of thinning.”
It could be that progestin causes “immunologic changes in the vagina and cervix” or could increase the H.I.V.’s “ability to replicate,” Dr. Morrison said.
At one point, the researchers measured the concentration of H.I.V. in infected women’s genital fluid, finding “there was more H.I.V. in the genital fluid of those using hormonal contraception than those who aren’t,” Dr. Baeten said, a possible reason men might have increased risk of infection from hormonal contraceptive users. Those women “don’t have more H.I.V. in their blood,” he said.
The researchers also found that oral contraceptives appeared to increase risk of H.I.V. infection and transmission, but the number of pill users in the study was too small to be considered statistically significant, the authors said.
Previous research on the pill has been more mixed than with injectables, which could have a greater impact because they involve a strong dose meant to last for three months, Dr. Baeten said.
In another troubling finding, results from the same study, published separately, showed that pregnancy also doubled the risk of women’s contracting H.l.V. and of infected women’s transmitting it to men. That may partly be due to increased unprotected sex, but could also relate to hormones, researchers said.
But there are no simple solutions, the authors acknowledge. Any warning against such a popular contraceptive method may not only increase complications from pregnancy but increase H.I.V. transmission, too, since pregnancy itself may raise a woman’s risk of H.I.V. infection.
First, the researchers and others say, greater emphasis should be placed on condom use along with hormonal methods.
Some experts, like Dr. Morrison, favor a randomized controlled trial for more definitive proof, but others question how to “randomize women who may have strong preferences about their contraception,” he added.
Dr. Ludo Lavreys, an epidemiologist who led one of the first studies to link injectable contraceptives to increased H.I.V. risk, said intrauterine devices, implants and other methods should be explored and expanded. “Before you stop” recommending injectables, he said, “you have to offer them something else.”
[October 3, 2011, http://www.nytimes.com/2011/10/04/health/04hiv.html?_r=1&ref=health&pagewanted=print ; N Valko RN, 4 Oct 11]
The Pill's Deadly Affair with HIV/AIDS
The U.S. is contributing to the spread of HIV/AIDS among African women by its reckless distribution of hormonal contraceptives of all kinds in so-called “reproductive health” programs.
The world's deadliest killer, HIV/AIDS, and the Birth Control Pill have been carrying on a secret and deadly "love affair" for decades.
While women swallowed their “freedom” with the morning orange juice, studies that should have made global headlines yellowed in medical journals, unknown to the general public.
Only doctors learned about the pills deadly affair with HIV/AIDS, and they were too busy writing prescriptions for hormonal contraceptives to talk.
More than 50 medical studies, to date, have investigated the association of hormonal contraceptive use and HIV/AIDS infection.
The studies show that hormonal contraceptives—the oral pill and Depo-Provera—increase almost all known risk factors for HIV, from upping a woman's risk of infection, to increasing the replication of the HIV virus, to speeding the debilitating and deadly progression of the disease.1
A medical trial published in the journal AIDS in 2009—monitoring HIV progression by the need for antiretroviral drugs (ART)—saw “the risk of becoming eligible for ART was almost 70% higher in women taking the pills and more than 50% higher in women using DMPA [Depo-Provera] than in women using IUDS.”2
Studies aside, it is well known that HIV/AIDS strikes more women than men. Some would argue that this is a result of the desire of men for young—and presumably uninfected, sexual partners. Few are willing to discuss a more obvious explanation, namely, that the Pill and Injectables render women particularly vulnerable to HIV/AIDS.
How serious is the problem? Oral contraceptives and Depo-Provera are among the world's most popular and prevalent contraceptive methods. According to one study, “Globally, at least 150 million women currently use hormonal contraceptive methods.”3 In America, hormonal contraceptive rates are over 52% in unmarried women—those at greatest risk of HIV/AIDS. Moreover, in the interest of lowering the birth rate, the UNFPA and USAID continue unloading boatloads of hormonal contraceptives on Africa, Haiti and other AIDS-ravaged developing nations.
The best meta-analysis done to date, done by Dr. Chia Wang and her colleagues, surveyed the consensus results of the 28 best published studies since 1985. They found that the “significant association between oral contraceptive use and HIV-1 seroprevalence or seroincid
ence … increased as study quality increased.” In fact, “Of the best studies, 6 of 8 detected an increased risk of HIV infection associated with OC [oral contraceptive] use.”4
On the National Scale
Moreover, Wang's results showed even more of a Pill/HIV link when they limited studies to those conducted on African populations. This is significant for two reasons:
First, sub-Saharan Africa is home to the world's earliest and largest heterosexual HIV/AIDS epidemic, which to date has infected an estimated 22.4 million5 people. This is two-thirds of the total number of infections worldwide.
Second, sub-Saharan Africa has endured decades of contraception-focused population control programs and countless hormonal-contraceptive trials. “Among the six [African] countries hardest hit by the HIV/AIDS epidemic … two in three users in the six countries rely on the OC (oral contraceptives) or injectables,”6 said Iqbal Shah of the World Health Organization.
Likewise, Thailand, praised for a contraceptive prevalence of 79.2% in 2000 and upwards of 70% today, is a land where, “More than one-in-100 adults in this country of 65 million people is infected with HIV.”7 Among Thai women, “Oral contraception is the most popular method.”8, 9
On the other hand, Japan's HIV rate is, at 0.01%, one of the lowest in the world.10 In this context, it is important to note that the birth control pill was illegal in Japan until 1999, and even today only 1% of Japanese women use oral contraception. Similarly, the predominantly Catholic Philippines, with a longstanding popular resistance to contraception, boasts an HIV “prevalence rate of only 0.02%.”11
Hormonal Changes Heighten HIV Risk
The studies that demonstrate a connection between hormonal contraceptives and HIV/AIDS infection postulate a number of mechanisms at work.
First, let's review the basics. The Human Immunodeficiency Virus (HIV), is carried in warm blood or sexual fluids. It infects through fragile, inflamed, bleeding or needle-pricked tissue, attacks specific T-cells in the immune system, and causes the incurable, debilitating condition known as AIDS (Acquired Immunodeficiency Syndrome).
Hormonal contraceptives increase almost all known risk factors for HIV infection.
Studies have found that hormonal contraceptives “alter the microenvironment of the female”12 and boost the cell count of those specific cells that HIV uses to infect and proliferate (HIV co-receptor CCR5 in cervical CD4+ T lymphocytes).
What is more, a progesterone side effect known to American women as “breakthrough bleeding,” is caused when hormonal contraceptives excessively thicken the uterine lining. The large, bleeding surface of the uterus creates an ideal site for HIV infection.
Progesterone also has an immunosuppressant effect, which means that women using hormonal contraceptives have less in the way of natural defenses against HIV and other STDs, such as chlamydial infection or genital herpes (HSV-2).13, 14 In one study, “HSV-2 infection itself more than tripled the risk of HIV infection.”15
In the vagina, increased blood and the independent hormonal effects of the Pill eliminate the natural pH acid protection against infection.
What is more, a famous study of rhesus macaques found that hormonal contraceptives thin the vaginal walls and markedly increase SIV infection (the monkey equivalent of HIV).16 Vaginal dryness, another side effect of hormonal contraceptives, is not only painful but also makes one prone to tears and abrasions—fertile sites for infection.
One study points out, “On a cellular level, hormonal contraceptives have been associated with cervical and vaginal inflammation.”17
Further, hormonal birth control causes the fragile cervical tissue to grow beyond its natural bounds and replace what would normally be thick, protective membrane. This “cervical ectopy” is dangerous because the cervix's thin surface is the main site of HIV infection.18
Given all these different ways that hormonal contraception promotes HIV/AIDS infection, it is not at all surprising that several studies show women on the pill, Depo-Provera, etc., are more likely to be infected with not just one, but several variants or strains of HIV. This “in turn leads to higher levels of viral replication and more rapid HIV-1 disease progression.”19, 20, 21
Women on hormonal contraceptives are not only more likely to contract HIV/AIDS, they are also more likely to pass it along to their sexual partners. The three studies which focused on “the impact of hormonal contraception on cervical shedding of the cell-associated virus”22 all found that HIV-positive women on hormonal contraceptives are far more likely shed HIV in their body fluids.
High-dose pill users were over 12 times more likely to shed the HIV virus than women not using contraception, low-dose users were almost 4 times more likely, and Depo-Provera users were 3 times more likely.23
The Pill Pushers Push Back
Some dismiss out of hand the impressive body of scientific research demonstrating a Pill/HIV link. They quote
from the handful of studies and highly selective trials which claim to find “no increase in HIV risk among users of oral contraceptives and Depo-Provera.”24
The problem with many of these studies, such as Mati et al. 1995, Kapiga et al. 1998, and Sinei et al. 1996 is that they were conducted with and through “family planning clinics.” Since the chief business of these clinics is the promotion, sale, and distribution of contraceptives, the possibility of bias is undeniable. Who would trust Marlboro to monitor a study on the link between cigarettes and cancer?
Moreover, the handful of studies that deny a link between hormonal contraception and increased risk of contracting HIV are dwarfed by the many studies that have not only found such a link, but convincingly explained precisely what it is about such contraception that contributes to the spread of the disease.
Yet population control groups continue to lobby for more contraception, not less.
Take Dr. Willard Cates, president of the Institute for Family Health of Family Health International (FHI), one of the major purveyors of hormonal contraception to the developing world. Wrote Cates to the Journal of American Medical Association, “Preventing unintended pregnancies among HIV-infected women who do not currently wish to become pregnant is an important and cost effective way of preventing new HIV infections of infants. … More must be done to ensure access to safe and effective contraception for HIV-infected women.”25
Obviously, FHI's concern here is less to prevent the infection of preborn infants, than to continue to contracept as many women as possible with your tax dollars and mine. What the organization refuses to admit, however, is that by doing so it is arguably contributing to the spread of the HIV virus.
How many lives are being lost because we continue to ship boatloads of hormonal contraceptives to a continent and to countries laboring under an HIV/AIDS pandemic? Isn't it time that we stopped?
See the full report in the upcoming May/June Issue of the PRI Review.
1 Baeten et al. 2003, “Hormonal Influences on HIV Disease and Co-Morbidites.” J Acquir Immune Def Syndr. 2005, Vol 38, Suppl 1: S19
2 http://www.iasociety.org/Article.aspx?elementId=11977; Stringer et al, AIDS. 2009, 23:1377-1382
3 Morrison et al., 2009, Best Practice & Research Clinical Obstetrics and Gynaecology 23 (2009) 264
4 Wang et al., 1999, JAIDS
6 Shah, I. 2003, J Acquir Immune Def Syndr, 2005
10 http://apps.who.int/globalatlas/predefinedReports/EFS2006/EFS_PDFs/EFS2006_JP.pdf. (Homosexual men account for just over half of Japan’s domestic HIV cases.)
12 Prakash et al. 2004; Prakash et al. 2002; Furth et al., 1990
13 Baeten et al. 2001; Cottingham et al. 1992; Avonts et al. 1990; Louv et al. 1989
14 Hunt et al. 1998; Zang et al. 2002; Gillgrass et al; 2003
15 http://www.iasociety.org/Article.aspx?elementId=10470; Baeten et al. 2007
16 Marx et al. 1996; Abel et al. 2004; Veazey et al. 2005
17 Baeten et al. 2001; Ghanem et al. 2005
18 Baeten et al. 2007; Critchlow et al. 1995; Louv et al. 1989; Plourde et al. 1994
19 Beaten et al. 2003; Poss et al. 1995; Long et al. 2000
20 Furth et al. 1990
21 Baeten et al. 2007, Clinical and Infectious Diseases, 360-361
22 Stringer et al. 2008
23 Wang et al. 2004; Mostad et al. 1997; Clemetson et al. 1993
24 Mauck, C. 2005, S11; Studies noted: Mati et al. 1995; Kapiga et al. 1998
25 JAMA. 2006; 296:2802
[http://pop.org/201004201199/the-pills-deadly-affair-with-hivaids , Population Research Institute]
By Joan Robinson