Guest Opinion: Does the Pill Promote HIV/AIDS in Africa?

If the risk of contracting HIV/AIDS is, say, 60 percent higher for those on hormonal contraceptives (and their partners) than for those who aren't, then we may be responsible in no small part for HIV/AIDS pandemic in Africa.  If even 10 percent of the cases of HIV/AIDS in Africa are a result of pushing the Pill on African women, then we have infected over two million people. Even one preventable death is too many.

FRONT ROYAL, VA (Population Research Institute) -  Epidemiologists have long been at a loss to explain the HIV/AIDS pandemic in sub-Saharan Africa.  It is surprising first of all in its sheer magnitude:  To date, an estimated 22.4 million  people have been infected, or more than twice as many as the rest of the world combined.  A second curious fact is that, unlike smaller epidemics elsewhere, HIV infections in Africa are not primarily limited to homosexuals, intravenous drug users and prostitutes.  Rather, they have riddled the general population.
 
We believe that population control programs-which are ubiquitous in Africa-created the conditions for the heterosexual epidemic that we now see.  It resulted in part from pornographic sex education and the massive distribution of condoms in "safe sex" programs.  These encourage risky sexual behavior, especially on the part of young people.  Medical infection through the use of contaminated needles and medical equipment has provided another vector for infection.  And then there is the birth control pill.  More than 50 medical studies, to date, have investigated the association of hormonal contraceptive use and HIV/AIDS infection. The vast majority of these studies show that hormonal contraceptives-the oral pill, Norplant and Depo-Provera-increase one or more risk factors for HIV.  In fact, hormonal contraceptives increase almost all known risk factors for HIV infection from upping a woman's risk of infection, to increasing the replication of the HIV virus, to speeding the debilitating and deadly progression of the disease.   Given all these different ways that hormonal contraception promotes HIV/AIDS infection, it is not at all surprising that several studies show women on the pill, Depo-Provera, etc., are more likely to be infected with not just one, but several variants or strains of HIV.  This "in turn leads to higher levels of viral replication and more rapid HIV-1 disease progression."    As if this weren't risk enough, these powerful, steroid-based drugs render women more susceptible to other sexually transmitted diseases as well, such as chlamydial infection or genital herpes (HSV-2).  This further increases their risk of contracting-you guessed it-HIV/AIDS.    If you have genital herpes, for example, one study showed that this "more than triple[s] the risk of HIV infection." The best meta-analysis done to date, done by Dr. Wang and his colleagues, surveyed the results of the 28 best studies published since 1985.  They found that the "significant association between oral contraceptive use and HIV-1 seroprevalence or seroincidence . . .  increased as study quality increased." In fact, "Of the best studies, 6 of 8 detected an increased risk of HIV infection associated with OC [oral contraceptive] use."   Moreover, Wang's results showed even more of a Pill/HIV link when they limited studies to those conducted on African populations.
 
Women on hormonal contraceptives are not only more likely to contract HIV/AIDS, they are also more likely to pass it along to their sexual partners.  The three studies which focused on "the impact of hormonal contraception on cervical shedding of the cell-associated virus"   all found that HIV-positive women on hormonal contraceptives far more likely shed HIV in their body fluids.   High-dose pill users were over 12 times more likely to shed the HIV virus than women not using contraception, low-dose users were almost 4 times more likely, and Depo-Provera users were 3 times more likely. All this would suggest that the U.S. is contributing to the spread of HIV/AIDS among African women by its reckless distribution of hormonal contraceptives of all kinds in so-called "reproductive health" programs.  We Americans ship over one hundred million "cycles" of birth control pills to Africa each year, not to mention over ten million injections of Depo Provera and tens of thousands of doses of Norplant.  In all, the U.S. alone sends enough contraceptives to Africa to chemically sterilize perhaps 15 million women.  The UN Population Fund, the European Union, and individual European countries are equally "generous" in their "reproductive health" programs.  The World Health Organization denies that hormonal contraception is a serious risk factor for HIV infection, but some of its own experts seem to think otherwise.  One of them, Iqbal Shah of the WHO, has noted that "Among the six [African] countries hardest hit by the HIV/AIDS epidemic . . . two in three users in the six countries rely on the OC (oral contraceptives) or injectables." So how many women in Africa have contracted the HIV virus because they were told to take the Pill or had Norplant implanted?   How many lives are being lost because we continue to ship boatloads of hormonal contraceptives to a continent and to countries laboring under an HIV/AIDS pandemic?   One medical trial published in the journal AIDS in 2009-monitoring HIV progression by the need for antiretroviral drugs-saw "the risk of becoming eligible for ART was almost 70% higher in women taking the pills and more than 50% higher in women using DMPA [Depo-Provera] than in women using IUDS."  If the risk of contracting HIV/AIDS is, say, 60 percent higher for those on hormonal contraceptives (and their partners) than for those who aren't, then we may be responsible in no small part for HIV/AIDS pandemic in Africa.  If even 10 percent of the cases of HIV/AIDS in Africa are a result of pushing the Pill on African women, then we have infected over two million people. Even one preventable death is too many.----- Steven W. Mosher is the President of the Population Research Institute.  Joan Claire Robinson is a researcher at Population Research Institute.

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