Just Say Yes to Condoms

The New York Times reports the very disturbing finding, just published in The Lancet Infectious Diseases, that women in Africa using injectable hormones (Depo-Provera or its generic equivalent) as a contraceptive are nearly twice as likely to become infected with HIV as are women using no method of contraception. This is scary stuff because if women stop using contraceptives out of fear that they will get HIV then they increase their risk of pregnancy, which generates a host of personal and societal consequences.

The findings potentially present an alarming quandary for women in Africa. Hundreds of thousands of them suffer injuries, bleeding, infections and even death in childbirth from unintended pregnancies. Finding affordable and convenient contraceptives is a pressing goal for international health authorities.Injectable hormones are very popular. About 12 million women between the ages of 15 and 49 in sub-Saharan Africa, roughly 6 percent of all women in that age group, use them. In the United States, it is 1.2 million, or 3 percent of women using contraception. While the study involved only African women, scientists said biological effects would probably be the same for all women. But they emphasized that concern was greatest in Africa because the risk of H.I.V. transmission from heterosexual sex was so much higher there than elsewhere.The study, led by researchers at the University of Washington and published in The Lancet Infectious Diseases, involved 3,800 couples in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the woman was already infected with H.I.V. Researchers followed most couples for two years, had them report their contraception methods, and tracked whether the uninfected partner contracted H.I.V. from the infected partner, said Dr. Jared Baeten, an author and an epidemiologist and infectious disease specialist.

The research analysis controlled for the use of condoms, which are still not widely accepted in eastern and southern Africa. At the end of the day, a dramatic increase in condom use is probably the only thing that can simultaneously reduce the spread of HIV and lower the birth rate in Sub-Saharan Africa. If only...