It has been clear for some time that steroid-based contraceptive drugs (they are not hormones) render a woman more susceptible to infection with the HIV virus. Why, then, are such drugs still being so aggressively pushed in places like Africa, where the risk of contracting AIDS is already high?
Thirty years after the Center for Disease Control (CDC) reported
the first US case of Acquired Immune Deficiency Syndrome (AIDS),
the disease continues to stretch its shroud of death across the
world. This, despite the billions of dollars that have been
invested in the development of vaccines, spent on anti-retroviral
therapies, and strewn about in condom distribution and sexual
education schemes.
But there is a strange and disturbing trend now evident in the
new cases of HIV/AIDS being reported, and it concerns women of
reproductive age.
According to the most recent report of the Joint United Nations
Programme on HIV/AIDS, published in 2009, close to 50% of all newly
acquired Human Immunodeficiency Virus (HIV)-1 infections across the
globe now occur in women of reproductive age. Only a decade before,
in 1998, only roughly 36% of reported cases concerned women of all
ages. Why this vast increase? Why, when treatment for HIV has
become more accessible and the overall death toll has slowly been
decreasing, are more and more women being infected? And why is the
increase concentrated in women in their childbearing years?
Heterosexual intercourse is the point of transmission for the
majority of these newly infected women. No surprise here. But sex
is not just sex these days. Heavily funded population control
programs have promoted, and even imposed, powerful, steroid-based
contraceptive drugs on tens of millions of Third World women. What
they trumpet as “greater global access to family planning
methods” has in fact given the HIV virus greater access to
women’s bodies by altering women’s local and systemic immunities,
cervico-vaginal responses and protective vaginal flora—all in
directions that make infection more likely.
Statistics gathered over the past 20 years reveal a parallel
between an increase in contraceptive drug use and an increase in
HIV-1 infections in women. Several epidemiological studies over the
same period also seem to demonstrate a link. These studies were
conducted with various cohorts of women from married mothers to
single adolescents to “sex workers”, and were carried
out, for the most part, among the populations of users of African
family planning clinics. A link between the use of contraceptive
drugs and HIV-1 disease acquisition and progression seemed evident,
although most of the studies—for whatever reason—failed
to draw any consistent or strong conclusions about this link. And
none suggested that family planning programs ought to be modified
or scaled back as a result.
One meta-analysis of 28 studies in 1999 suggested a positive
association between oral contraceptives and HIV-1 incidence. A
later study, however, carried out in 2006, claimed that there was
no overall risk of acquiring HIV-1 as a result of such drug use.
Such disparate results enable the promoters of population control
programs to continue to rely on such contraceptive drugs, claiming,
“the science is not settled.” Many of the organizations
involved in such programs are, for obvious reasons, reluctant to
offer clarity to women on the correlation between contraceptive use
and HIV- disease prevalence in women. Indeed, several studies
almost seem designed to deliberately obscure this fact.
Additional evidence of such a link comes from other studies that
conclusively demonstrate that hormonal contraceptive use is
positively associated with an increased risk of several other
sexually transmitted infections (STI’s) such as Chlamydia.
So why are the studies involving HIV-1 transmission so
inconclusive? Reasons include poor controls on variables such as
age and sexual lifestyle variants, infrequent assessment, lack of
follow-up and widely varying contraceptive delivery methods.
Attempts at rendering comparative data are difficult, and some of
the statistical compilations and some of the meta-analytical
efforts, seemed designed to serve population politics.
There are other lacunae as well. Few studies consider the
different effects of estrogen and progesterone—and their
synthetic steroid-based counterparts–on vaginal and cervical
structure and immunity. The studies that have been done broadly
compare “hormonal contraceptive” use to HIV-1
acquisition and progression across a diverse range of
deliverables–oral, injectible, intra-uteral, etc.—that are
lumped together under one generic “hormonal
contraceptive” title. The most common such amalgamation,
Combined Oral Contraceptives (COC’s), consists of both hormonal
(estrogen-like compounds) and steroidal (progestin) agents that
work together to prevent ovulation, taken daily as “the
pill.”
Other forms of contraceptive delivery include progestogen-only,
such as the high-dose injectables Depo-Provera (DMPA) and
Noristerat, moderate-dose pills, low-dose subdermal implants and
laced intra-uterine devices (IUD’s). These steroidal forms of
preventing pregnancy affect the female reproductive system somewhat
differently than their estrogen-like counterparts. In low-dose
delivery regimens, progestins cause a thickening of cervical mucus
inhibiting sperm viability and penetration. In high-dose delivery,
cervico-vaginal changes also occur: follicular development is
halted along with ovulation and the endometrium is thinned. The
progestogen-only effects are clear: they weigh heavily on women’s
cervico-vaginal structure and protective flora, hence reducing a
woman’s ability to ward off infection. As far back as 1991 abnormal
changes in the condition of the cervix was found to be strongly
been associated with increased susceptibility to HIV/AIDS
acquisition.
The chain of reasoning is straightforward: Women who take
drug-based hormonal and steroidal contraceptives are at increased
risk of STI’s. HIV/AIDS is an STI. Therefore, women who take
powerful steroid-based drugs called “hormonal
contraceptives” are at increased risk of contracting the HIV
virus.
It’s time that researchers and policy makers faced these facts
responsibly, for women’s sake.
Jennifer Kimball, Be.L., is the Executive Director of the Culture of Life Foundation.
Steven W. Mosher is PRI’s President and the author of Population Control:
Real Costs and Illusory Benefits.
