- HIV disease progression by hormonal contraceptive method: secondary analysis of a randomized trial -
Elizabeth M. Stringer, Jens Levy, Moses Sinkala, Benjamin H. Chi, Inutu Matongo, Namwinga Chintu and Jeffrey S.A. Stringer
- Hormonal Contraception and HIV Disease Acquisition: A Limited Review and Reassessment of Findings -
SAN FRANCISCO - More than 40 women sued the makers of a popular birth-control patch Wednesday, claiming the contraceptive caused serious illnesses and at least one death.
The World Health Organization's headquarters and its Regional Office for Africa convened an Africa regional meeting in Nairobi, Kenya, on September 19 to 21, 2005, on the topic of hormonal contraception and HIV acquisition.
The Provision and use of Progestogen-only Contraceptives amongst Antenatal and Postpartum Women in a Rural area in the Eastern Cape
Health Systems Trust
Executive Summary ----------------- In South Africas public sector maternity services, injectable progestogen-only contraceptives (POCs) have been typically administered immediately after delivery to women choosing to use these methods. POCs are hormonal methods, which contain a progestogen similar to the natural hormone that a womans body makes. POCs have been approved as a safe and effective contraceptive method by major international regulatory bodies such as the Federal Drug Administration (FDA) of USA, and the International Planned Parenthood Federation (IPPF) as well as locally, by the South African Medicine Control Council. In South Africa, POCs are on the Essential Drug List for Primary Health Care. This has become a popular contraceptive method amongst many women all over the world, in particular in South Africa, where it comprises 49% of current method use. A series of studies arose in response to the draft South African National Contraceptive Guidelines (1999), which recommended that women be advised to delay use of POCs until six weeks postpartum. This recommendation followed the international guidelines of the WHO and the IPPF, which were based on theoretical concerns that the early transfer of small amounts of hormones to the infant through breastmilk, may affect its growth development. The studies sought to investigate the feasibility of recommending this delay in POC administration, taking into account both the mothers risk of pregnancy in the early postpartum period and her ability to return to a health service at six weeks post-delivery, to initiate a method of contraception. Studies were conducted in 2000 in Gugulethu, which is an urban area in Cape Town and in 2001, in Stellenbosch in the rural Western Cape. A further need arose to investigate and explore these issues in an area where conditions would be different to the Western Cape. Hence, a similar study was conducted in a rural area of the Eastern Cape. A site where the Health Systems Trust, active as the Initiative for Sub-District Support (ISDS) was chosen as a study area. For the purpose of this research we undertook an extensive literature review of the effects of the use of POCs on breastfed infants in the postpartum period. This literature review did not find any scientific evidence to support possible adverse effects on the infant. In addition, a quantitative survey was conducted amongst 346 women attending the child health clinic (CHC) and amongst 346 women attending the antenatal clinic (ANC) at St Patricks Hospital, in Bizana in the Eastern Cape. The women were interviewed to determine contraceptive knowledge and contraceptive use, practices concerning contraceptive use pregnancy risk in the early postpartum period knowledge of the time they are likely to become pregnant, the feasibility of delaying POC initiation access to contraceptive services with regards to time, transport and costs and breastfeeding practices and patterns of sexual activity in the postpartum period. The results of the survey were as follows: Most women were able to access health services without difficulty. Contraceptive use was low, at 29%. Six percent of women may be at risk of becoming pregnant, as they were not exclusively breastfeeding and were sexually active within the first six weeks, postpartum. Seventy-eight percent and 75% at the CHC and ANC respectively, lacked good knowledge about the time they were most fertile. Most women did not regard exclusive breastfeeding as a reliable method of contraception (40% and 47%, at the CHC and ANC respectively). Disturbingly, nearly 20% of the women experienced difficulties if they refused sexual intercourse with their husbands or partners. A workshop was held with stakeholders (Health Systems Trust and health service providers) in February 2003. The purpose of the workshop was to report on the findings in order to make recommendations regarding ways in which to improve the quality of contraceptive and other reproductive health services provided. This final report has been written on the basis of the study findings as well as feedback during this workshop. The National Contraceptive Policy Guidelines, published subsequent to this study, have been amended from the original draft and recommend that women be given a choice about the timing of post-partum POC initiation, after appropriate counselling. Arising from this study, it is further recommended that effective implementation of the guidelines require that providers counsel women appropriately about the theoretical risks of immediate post-delivery POC initiation and assist women in their assessments of postpartum pregnancy risk (i.e. their intentions regarding and ability to negotiate resumption of sexual relations their ability to use barrier method contraceptives the feasibility of exclusive breastfeeding for at least six weeks post-delivery and the feasibility of visiting a clinic six weeks postpartum to initiate a contraceptive method). POCs should be available immediately after delivery for women who choose not to delay initiation of sexual activity or for those who have no choice in delaying sexual activity. The provision of adequate information will assist women in making informed choices with respect to their reproductive health.
A male pill is potentially the next step after the successful Australian trial of a treatment that switches off sperm production. The five-year study, led by Professor David Handelsman from the ANZAC Research Institute in Sydney, involved 55 Australian couples, none of the women became pregnant while on the trial. Professor Handelsman said the method would eventually have men taking an injection every three to four months. Eventually the treatment could be available in tablet form, but Professor Handelsman said he didn't see this happening in the near future. This was a very important study because it was the first to ever use an approach that could go forward into practical development that involved a combination of two hormones [progestin and testosterone]. The men in the trial were given a testosterone implant every four months and injected with progestin every three months. They [hormones] switch off sperm production but in doing that, it switches off a man's own testosterone so we have to replace that, Professor Handelsman said. It's very similar to the way female hormonal contraceptives work, whether an oral or implantable contraceptive. Professor Handelsman, a leading specialist in male reproductive health, said after 12 months on the program, the men would stop their treatment to recover their fertility. FPA Health medical director Dr Terri Foran said the study's positive results were very exciting and developing a male pill was the next step. It's not going to be everybody's cup of tea but for some couples, it will be a really useful option. Professor Handelsman said the commercial manufacture of the treatment was now up to the pharmaceutical companies. But we've proved it's possible to do it. Police officer Chris Hains, from south-west Sydney, joined the trial in 2000 after his wife Nicole was having problems with taking Depo-Provera, a contraceptive injection given every three months. Every three to four months, doctors implanted testosterone under Mr Hains's abdominal skin under local anaesthetic. Apart from the discomfort of the incision, Mr Hains said the only side-effect was increased libido: From my point of view it had a positive side-effect, he said. About seven months after leaving the trial, Mrs Hains fell pregnant with now four-month-old son, Although the treatment was tested on men in relationships, Mr Hains said it would also be popular with single men. ( Source: Personalized Pop Reporter, 6 October 2003.
Pharmacies are doing a brisk trade in the morning-after pill, especially among teens. It seems that even though there is a high risk of contracting HIV/AIDS, young people are still having unprotected sex and are concerned simply with preventing unwanted pregnancies. A spot survey conducted by The Star of a number of pharmacies around Johannesburg, revealed that chemists are doing a roaring trade in the three available types of morning-after pill. E-GEN-C, NorLevo and Ovral 28 must be orally ingested by a woman within 72 hours of her having had unprotected sex. The pills can be obtained over the counter without prescription and it seems young women are taking advantage of this. Graham Naughtin, a pharmacist at the Cliffview Medicare Pharmacy at Cresta, says that about 70 boxes of the morning-after pill are sold every weekend. While they are 90% effective in preventing pregnancy, they do not protect the user against any sexually transmitted infections (STIs) or AIDS.A locum doctor at the Selgo Pharmacy in Braamfontein, Blessing Motgatlha, says she has noticed a 50% increase in the use of the morning-after pill in the past two years. Lipalesa Malebanye, a pharmacist at Bruma Pharmacy, says where condom usage has dropped, there is a notable increase in the use of the morning-after pill, especially by teenagers. A teenager, who does not want to be named, says she has taken the morning-after pill four times this year alone. She adds that contracting an STI was not something she was concerned about at the time. While these drugs might prevent unwanted pregnancies, they do have side effects. Professor Basil van Iddekinge, a gynaecologist at Wits Medical School, says the morning-after pill is not meant for continuous or repetitive use and he stressed that it is not a long-term contraceptive. A women should rather use a non-emergency, long-term type of contraceptive. Van Iddekinge says one of the main problems of the morning-after pill is that it may alter the user's menstrual cycle. He explains the emergency pill is meant to be just that, used in an emergency. An emergency would be when the condom broke during intercourse, or perhaps when a woman has sex even though she did not intend to do so. Another emergency would be in the case of rape. Meanwhile, loveLife CEO, David Harrison, says the awareness organisation has not picked up this trend. If this is the case, it is really worrying that young people are being more irresponsible in their sexual activities, he says. Harrison warns that youngsters should employ dual protection to prevent pregnancy and STIs. The chief director of maternal, child and women's health unit in the department of health, Dr Eddie Mhlangu, holds Harrison's point of view. It's worrying, on the one hand, that people are not using condoms despite the threat of AIDS, while on the other, it is encouraging that it is cutting down on the number of unwanted pregnancies, he says. (Source: The Star, 14 April, 2003).
Adolescent sex and contraceptive experiences: Perspectives of teenagers and clinic nurses in the Northern Province
Health Systems Trust
Prevention of unwanted adolescent pregnancy through effective contraceptive use is a national health priority. The aim of this research was to contribute towards such improvements in services in the Northern Province through developing in-depth understandings, from the perspectives of teenage women and clinic nurses, of: barriers to effective contraceptive use and how to overcome these teenagers contraceptive-seeking practices teenagers perceptions of methods and side-effects and perceptions of adolescent sexual activity and pregnancy. Qualitative methods were used and the research was conducted around Pietersburg (mainly in semi-rural areas). Thirty-five in-depth, semi-structured interviews and 5 group discussions were held with adolescent women, recruited from clinic waiting-rooms and schools, and nursing staff in 14 clinics were also interviewed.