What Works for Women and Girls

for infectivity) were inconsistent (Curtis et al., 2009). (Gray III) (contraception, familyplanning)A multi-country cohort analysis comparing the incidence of HIV disease progressionamong anti-retroviral therapy-naïve women with and without exposure to hormonalcontraception at 13 sites in Africa and Asia found no association between hormonalcontraceptive use and HIV disease progression. Between August 2002 and December2007, the MTCT-Plus programs enrolled 7846 women. 4109 (52%) women met theeligibility criteria for this analysis and contributed 5911 person-years of follow-up. Atbaseline, 3064 (75%) women reported using either no contraception or a nonhormonalmethod, whereas 823 (20%) reported using implants/injectables and 222 (5%) reportedusing oral contraceptive pills. The disease progression outcome was met by 944 (29%)women. Neither implants/injectables nor oral contraceptive pills were associated withdisease progression (Stringer et al., 2009). (Gray III) (contraception, family planning,PMTCT)A study of 4,200 HIV-negative women in South Africa ages 35 to 49 years of age foundthat during 5,010 person years of follow-up, 111 women acquired HIV. Of the 4,200women, 21% used hormonal contraception, of which 14% used DMPA and 5% norethindroneenanthate. After adjusting for sexual risk behaviors and STIs, the incidenceof HIV was similar among women using combined oral contraceptives, DMPA andnorethindrone enanthate compared to women not using any hormonal contraceptives.“The conflicting evidence regarding the potential role of hormonal contraception inincreasing women’s risk of HIV infection would appear to demand further epidemiologicalinvestigation. However, any true association is likely to be small…In the caseof hormonal contraception and HIV infection, it is unclear whether more definitiveevidence is likely to emerge from observational epidemiological studies…” (Myer et al.,2007b: 173.). (Gray III) (contraception, DMPA, South Africa)A study with 13 years of follow-up in Uganda which assessed the association betweenhormonal contraceptive use on time from HIV seroconversion to death from 1994 to2006 with 625 women found that hormonal contraception was not associated with anincreased risk of death in HIV-positive women and “thus does not support the concernthat hormonal contraception accelerates time-to-death among HIV-infected women”(Polis et al., 2009). (Gray III) (contraception, Uganda)An observational prospective cohort study of 498 HIV-positive women in Kenya andZimbabwe with CD4 counts equal to or greater than 500 who used a contraceptivemethod of their choice and were followed up every six months for four years was notassociated with HIV disease progression. Of the 363 women who used their contraceptivemethod consistently for a mean of two years, 135 (37%) used DMPA; 85 (23%) usedoral contraceptives and 143 (39%) used non-hormonal methods. DMPA users and oralcontraceptive users had a similar change in CD4 count in comparison to women usingnon-hormonal contraception methods; change in HIV viral load was not significantlyWHAT WORKS FOR WOMEN AND GIRLS193