By Caila Brander, NWHN Policy Fellow for Challenging Dangerous Drugs and Devices
Researchers studying the link between contraceptive use and HIV have uncovered a connection between using the Depo-Provera and contracting HIV. In light of these findings, the World Health Organization (WHO) has changed its safety classification for injectable contraception.
Depo-Provera is the most widely used injectable contraception around the world, and only progestogen-only injectable contraception approved in the U.S. The other progestogen-only form of injectable contraception, NET-EN, is not approved in the U.S. The progestogen hormone is administered through an intramuscular shot and prevents ovulation for three months. A woman returns after three months to get the next shot. Injectables are one of the most highly effective methods of contraception available.
Roughy 5% of women in the U.S. who use contraception use injectables, often Depo-Provera. However, it is noteworthy that this percentage is higher for teenagers; 8% of U.S. teens using contraception choose injectables. Since 1 in 5 new HIV cases occur in teenagers and young adults (ages 13-24), an association between injectable contraception and HIV is highly relevant to contraceptive care in the U.S.
Is Depo-Provera safe? According to the WHO, the answer just changed from “Absolutely!” to “Well, for most people, but not for all.” This is because studies have found a small but statistically significant correlation between using Depo-Provera and contracting HIV. Although there is definitely a need for further investigation, the WHO decided to be proactive and bump the Medical Eligibility Criteria (MEC), a safety classification, down from 1 to 2 for Depo-Provera. The MEC 1 classification means there are no safety concerns, anyone can use it. MEC 2 means that although the risks outweigh the benefits for most people, it’s not entirely safe for everyone. In this case, it means Depo-Provera is not safe for those who are at high risk of being exposed to HIV.
The tricky part is: how do you know if you’re at risk? The CDC says that many people in the U.S., even those at high risk of exposure, do not get tested for HIV because they do not believe they are at risk. Whether or not you are considering using Depo-Provera, it is extremely important to know your HIV status, even if you don’t think you’re at risk.
There are many factors to weigh when deciding which form of birth control to use. Depo-Provera has been controversial for many years in the U.S. because of concerns over the drug’s impact on bone mineral density. The National Women’s Health Network has worked to ensure these safety concerns have reached the consumers who might choose Depo-Provera. On the other hand, injectable contraception offers many benefits. It is discreet and does not require remembering to take a pill every day.
The risks and benefits of contraceptive use vary from woman-to-woman. The NWHN feels women should have access to information about drug safety in order to weigh their options. With the assistance of their healthcare provider, women should be able to decide on the best option that is right for them.