Business as usual. That’s the message from the World Health Organisation following its experts meeting last month to review the safety of hormonal contraceptives where there is a risk of HIV transmission.
A study published in The Lancet last October found that hormonal contraceptives — particularly injectables such as Depo Provera — doubled the risk (compared with those not using hormonal contraception) of a woman contracting HIV from her infected partner or, if she is the infected one, of transmitting it to him. The effect was particularly strong for the youngest women – the age-group driving the AIDS pandemic in sub-Saharan Africa.
But after a two-day technical consultation among 75 experts from 18 countries, WHO has decided not to review its guidelines on contraceptive safety. It has only re-emphasised the need to use condoms as well.
Current WHO recommendations in the Medical eligibility criteria for contraceptive use (2009 edition) therefore remain: there are no restrictions on the use of any hormonal contraceptive method for women living with HIV or at high risk of HIV. Couples seeking to prevent both unintended pregnancy and HIV should be strongly advised to use dual protection – condoms and another effective contraceptive method, such as hormonal contraceptives.
“Dual protection” — against pregnancy, first and foremost, you understand. Pregnancy being a worse disease than HIV in WHO circles, although it only brings another life into the world compared with killing people or making them desperately ill.
Oh, and where’s the call for more and urgent research on the contraception-HIV link, for the clinical randomised trial that the authors of last year’s study said would be necessary to “definitively assess HIV-1 risk from different contraceptive methods”. No word of it this week.
Just remember, these judgements and policies are being made by elites who are unlikely ever to have used injectable contraceptives — or even the pill, since the majority, I’ll wager, are still men — and who, if they do happen to be at any risk of HIV will get all the help that’s available, pronto. Why should they care about African lives when their basic agenda is to prevent them?