The common hormonal birth control shot depot-medroxyprogesterone acetate, known more commonly as DMPA and sold as Depo-Provera, has been linked to an increased risk of HIV infection in women. A study published in February 2018 in Endocrine Reviews found that the progestin MPA used in the DMPA shot both increases the permeability of the female genital tract (promoting HIV-1 uptake) and suppresses parts of the immune system. When the cells in the genital tract come into contact with HIV, MPA acts like the stress hormone cortisol.
“Human studies suggest DMPA use may raise the risk of HIV infection in exposed women by about 40 percent,” explained Zdenek Hel, Ph.D., professor in the University of Alabama at Birmingham Department of Pathology, UAB School of Medicine, and co-author of the study. “Importantly, we know that some other forms of contraceptive methods do not show the same deleterious effect on the immune function in cell culture, small animals or human studies.”
A 2012 observational study that included HIV-1 serodiscordant couples (meaning the woman does not have HIV while her partner is infected) in sub-Saharan Africa determined that risk of HIV infection was lower with other forms of contraception including sterilization, intrauterine devices, and hormonal implants. When women are given this particular DMPA hormonal birth control shot it may increase their risk of acquiring HIV by 1.4-fold.
“The increased rate of HIV infection among women using DMPA contraceptive shots is likely due to multiple reasons, including decreases in immune function and the protective barrier function of the female genital tract,” explained Janet P. Hapgood, Ph.D., University of Cape Town, South Africa; Hel; and Charu Kaushic, McMaster University, Hamilton, Ontario, Canada. “Studying the biology of MPA helps us understand what may be driving the increased rate of HIV infection seen in human research.”
More than half of the 36.7 million people living with HIV reside in eastern or southern Africa, and DMPA is the primary birth control used in sub-Saharan Africa. It is used by over 50 million women around the world.
Obianuju Ekeocha, an African woman and pro-life activist argues that the women of Africa do not want contraception in the first place and when Western countries come to Africa with birth control and abortion, it is a form of ideological colonization.
“Why don’t you listen to the people first?” she asked in an interview with BBC news. “In all this talk about contraception, the one thing that I have never heard of in all my time trying to track all these things is something like the side effects of contraception. No one ever tells the African women, when they come to promote contraception across the different African countries.”
“My lifeline out of poverty was education,” Ekeocha continued. “It was not contraception. And there are so many other women who have walked the same path as I have without ever having to take recourse to some contraception provided by the British government or the United States government.”
Ekeocha states that access to food, water, and basic healthcare is what lifts women and children from poverty, not access to birth control or abortion. Now it seems that DMPA, the most common hormonal birth control that Western countries have brought to Africa, is increasing African women’s risk of acquiring HIV.