Please note: This archive was last updated in 2005.

RHO archives : Topics : Contraceptive Methods

Hormonal contraception, IUDs, and HIV risk

Hormonal contraception includes a group of modern contraceptive devices such as oral contraceptives (the pill), injectables (DepoProvera, "the shot"), and contraceptive implants (Norplant ). When used properly, these methods, like intrauterine devices (IUDs), provide reliable, consistent protection against pregnancy. Women who use hormonal contraceptive methods or IUDs often are in stable relationships, and use contraception to prevent pregnancy rather than to protection against STI transmission.

Investigators are working to determine if hormonal contraceptives or IUDs themselves might affect a woman's risk of HIV. Some studies have suggested that contraceptives containing high levels of progestins, including injectables and some oral contraceptives, may increase a woman's risk of HIV by promoting certain physiological changes (PATH/Outlook 1999). Hormonal contraceptives all contain progestins, synthetic versions of the hormone progesterone, and also may contain estrogen. Progesterone has been found to cause endometrial, cervical mucus, and bleeding changes that might affect STI/HIV risk (Mostad 1997). Estrogen alters the degree of cervical ectropion, which may affect users' susceptibility to certain infections.

A Kenyan study of HIV-positive women found that use of oral contraceptives and the three-month injectable DMPA may be associated with increased endocervical shedding of HIV (Mostad 1997). Another study, among sex workers in Nairobi, Kenya, concluded that oral contraceptives may increase risk of HIV infection (Plummer 1991). However, methodological questions concerning both studies have been raised, making it difficult to interpret the results (PATH/ Outlook 1999). Other studies have shown no association between use of hormonal contraception and increased risk of HIV, including a study of Rwandan women attending prenatal and pediatric clinics (Allen 1991) and a study of Kenyan women attending family planning clinics in Nairobi (Mati 1995). Concern that increased menstrual bleeding and possible increases in upper genital tract infections might put IUD users at higher risk for HIV has been raised by some studies (Costello Daly 1994) but discounted by others (Mati 1995).

Recent updates discussing results from research about the effect of hormonal contraception on HIV acquisition, transmission, or disease progression have found that while there are biological and physiological reasons to believe that use of hormonal contraception could facilitate HIV acquisition, study results are conflicting. Also, since many of the studies have been conducted among sex workers, some findings have not been corroborated, and further research among other populations is needed (Morrison and Best 2004; FHI 2001).

Further data are required before definitive conclusions can be made regarding use of hormonal methods or IUDs and the risk of HIV. Family planning providers should inform clients that hormonal contraceptives and IUDs do not protect against STIs, including HIV, and that use of male or female condoms is strongly recommended for the protection of both partners .