The issue of whether use of hormonal contraceptives such as Depo Provera may increase risk of HIV transmission in both directions (from male to female and from female to male) has cropped up on this blog a couple of times and several more times on the Don't Get Stuck With HIV blog. Three months ago, when a paper was published suggesting a possible danger of increased HIV transmission, the WHO, UNAIDS and others recommended doing nothing until they held a 'high level consultation' in January. Apparently that consultation is still on the cards, if this podcast is anything to go by (Podcast 4: Hormonal Contraception and HIV).
The podcast goes through the motions of rubbishing the publication that suggested Depo Provera and similar contraceptives may be dangerous, as various factions of the HIV industry did several months ago. However, their pronouncements on the subject seem somewhat disingenuous; the uncertainty about the safety of Depo Provera, both the pills and the injectible form, runs both ways; things may not be as bad as the research suggests, but it may be a whole lot worse. For those previously advised to keep taking the injections or the pills, they might need to make a decision now. Because trials, we are told, could take four to five years.
It remains to be seen whether people using the product will happily keep using it for four to five years in the hope that the research was wrong and they are in no danger, and that all the evidence produced in the past suggesting that hormonal contraceptives are not safe will turn out to be mistaken, or whether they will stop using the product and wait till they get the all clear, even if that happens to be four to five years from now. I would certainly choose the latter!
Yet again, UNAIDS are advising people who are using Depo Provera, oral or injectible, to also use condoms. Somehow, I don't think people are as moronic as these bureaucrats imagine. Condoms will protect people against HIV and other sexually transmitted infections and they will also prevent unplanned pregnancies. Even if there were no questions about the safety of Depo Provera, many would question the need to use two contraceptive methods. But where there are such important questions it would seem unnecessarily risky as well.
There is a good review of the current evidence about Depo Provera and other issues on the Don't Get Stuck With HIV website, for those who wish to practice safe sex and avoid unplanned pregnancies but don't wish to wait four to five years to find out if their contraceptive method is really safe.