By Kelvin Mbewe
Over the centuries, women have used a variety of methods to prevent pregnancy. Modern contraceptive methods using hormones have been in use for decades. They were in the news this week when results of a large-scale clinical trial were released in Durban at the 9th South African Aids conference.
The ECHO study was designed to provide a clear answer to the question: is there a link between a commonly used hormonal contraception and HIV?
There had been studies that suggested an association between DMPA, the three-month injection commonly called Depo, and HIV. But those studies had limitations, because they were not designed to answer the question about a possible HIV link. The ECHO study set out to find out. Almost 8000 women who were sexually active, but did not want to fall pregnant, were randomly assigned one of three contraceptive methods: Depo or an upper-arm implant (also hormone based) or a copper device inserted into the uterus. The study cost US$ 50 million and enrolled almost 8000 women participants from Zambia, Eswatini, Kenya and South Africa.
The results were announced at the 9th South African Aids conference in Durban on Thursday.
Simultaneously, a session on results was also held in Lusaka for journalists and health advocates.
Good news, there is no link. The ECHO trial found no substantial difference in the rates of HIV infection among three groups.
Speaking at the journalist’s event in Lusaka, Modesta Chileshe, who is a Community Coordinator at the University of North Carolina, and supported the ECHO team in Zambia, explained the study in more detail. The study gives us clear evidence that there is no link between any of the family planning methods used and HIV.
But HIV and Family Planning advocates say the time spent supporting participants during the three-and-a-half-year study also taught them valuable lessons. In Durban, members of the ECHO trial’s Global Community Advisory Group (GCAG) said the trial was an excellent opportunity to hear women’s wishes around contraception. They said regardless of the results, women must be able to choose the form of contraception they prefer – even if they are all safe, they must be given the choice that suits their lifestyle best. Family Planning and HIV services must put women at the centre. This is also an opportunity to call for the availability of PrEP, the once-a-day pill that prevents HIV infection. While contraception does not increase a woman’s risk of becoming HIV infected, she is at risk if she has unprotected sex and if PrEP is not used – most especially in Southern and East Africa, where rates of infection are high.
Next steps to watch for are possible new guidelines on hormonal contraception by the World Health Organization. The ECHO trial gave us clear evidence that put to rest lingering doubts about hormonal contraception. But it also gave advocates and scientists a clear signal that women must be heard when they say they want health services that puts them at the centre, so that they can choose the most modern and most suitable forms of contraception and HIV prevention in one place.