Bulletin of the World Health Organization

Population-level impact of hormonal contraception on incidence of HIV infection and pregnancy in women in Durban, South Africa

Gita Ramjee & Handan Wand

Objective

To estimate the potential impact of using hormonal contraceptives on rates of infection with human immunodeficiency virus type 1 (HIV-1) and pregnancy by theoretically removing the use of hormonal contraceptives from a study population.

Methods

A prospective cohort study included 3704 HIV-negative women who were enrolled in two biomedical trials that tested two vaginal microbicides (PRO 2000 and Carraguard®) for the prevention of HIV-1 in Durban, South Africa, in 2004–2009. Cox proportional hazards regression models along with partial population attributable risks (PARs) and their 95% confidence intervals (CIs) were calculated to assess the relative population-level impact of the use of hormonal contraceptives on HIV-1 seroconversion rates and on pregnancy rates.

Findings

Women who reported using hormonal contraceptives at enrolment in the trial had a higher risk of HIV-1 seroconversion (adjusted hazards ratio: 1.24; 95% CI: 0.97–1.58) than women who reported using other types of contraceptives at enrolment. At the population level, the use of hormonal contraceptives (pills or injectables) at baseline and during study follow-up accounted for approximately 20% (95% CI: 16–22) of HIV-1 seroconversions. However, the partial PAR indicated a relative impact of 12% (95% CI: 9.0–15.7). On the other hand, 72% (95% CI: 66–77) of the pregnancies could have been avoided if all women had used hormonal contraceptives.

Conclusion

Women using hormonal contraceptives need comprehensive counselling on simultaneous prevention of HIV-1 infection.

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