Science Faculty seminar series: Do some contraceptives increase susceptibility to infections such as HIV in women, or transmission from women to men?
Professor Janet Hapgood, from the Department of Molecular and Cell Biology at UCT will present a talk entitled, "Do some contraceptives increase susceptibility to infections such as HIV in women, or transmission from women to men?"
There are many different forms of female non-hormonal and hormonal contraception, which vary in the method of delivery and the type of synthetic progestin compound used in hormonal contraception. Progestins are designed to mimic the actions of progesterone, the active contraceptive ingredient of hormonal contraceptives. About 144 million women worldwide use hormonal contraception, including about 41 million who use injectable contraceptives. Long acting injectable contraceptives are used by about 20 million women in Sub-Saharan Africa, where the incidence and prevalence of AIDS is high. In fact, there is a correlation between worldwide usage of injectable contraceptives and high HIV prevalence. Women account for half of global HIV-1 infections and more than 60% of new infections in sub-Saharan Africa. Young women have a much higher HIV prevalence than men of same age in some HIV high risk areas of South Africa, with HIV prevalence of about 25% in young women. Thus while young women are most at risk, they also have the greatest need for effective contraception. Prospective clinical studies show that some, in particular the injectable contraceptive Depo Provera, but not other progestins, increase the risk of HIV-1 infection and transmission, particularly in young women, by up to about 2-fold. However, these studies are considered to provide insufficient evidence by the World Health Organization (WHO) for discontinued usage of Depo Provera for women at high risk of HIV acquisition. This decision is mainly based on the arguments that the data is not obtained from randomly controlled trials and may be confounded by multiple behavioral factors, as well as the need to avoid increased maternal and infant mortality upon withdrawal of acceptable forms of contraception. WHO currently recommends that women on Depo Provera should use condoms. Controversial randomly controlled clinical trials have recently been approved to further investigate the effects of Depo Provera and other forms of contraception on HIV-1 acquisition. Access to affordable and safe contraception is thus an enormous public health issue, particularly in the developing world. This topic is the subject of intense worldwide research and debate in the public domain and the scientific literature. The speaker will discuss some current research strategies and ethical considerations regarding the above topics. She will also explain her central hypothesis and present some results from her laboratory which addresses at a cellular and molecular level the best choice of contraceptive for minimal effects on HIV-1 acquisition in women.