The complex relationship between research and global health policy is no better illustrated than by the ongoing discussion regarding the association between HIV acquisition and hormonal contraception, and in particular, progestogen-only injectable contraceptives (POIs). Despite an array of epidemiological, translational, and basic science research, the question persists as to whether there exists a causal increased risk of HIV acquisition in women who use POIs. Most recently, in August 2016 Polis et al. published in the journal AIDS an updated systematic review of the available clinical literature.1 The authors concluded that the highest-quality studies suggest a hazard ratio of 1.4 (95% confidence interval, 1.2 to 1.7) for HIV acquisition in women who use the POI depot medroxyprogesterone acetate (DMPA).
While the currently available scientific evidence demonstrates substantial uncertainty as to whether or not the association between DMPA use and HIV acquisition is causal, the need for up-to-date policy reflecting current findings is often more urgent than waiting for definitive research. The implications of this research for women in areas with high HIV prevalence, such as sub-Saharan Africa, are significant as many of the same countries with high HIV prevalence also experience high maternal morbidity and mortality. Contraceptive use plays a critical role in preventing maternal morbidity and mortality by helping women avoid unintended pregnancy.2 But unmet need for …
