title: Hormonal contraception, sexually transmitted diseases, and risk of heterosexual transmission of human immunodeficiency virus type 1.
abstract: To examine associations between method of contraception, sexually transmitted diseases (STDs), and incident human immunodeficiency virus type 1 (HIV-1) infection, a prospective observational cohort study was done among female sex workers attending a municipal STD clinic in Mombasa, Kenya. Demographic and behavioral factors significantly associated with HIV-1 infection included type of workplace, condom use, and parity. In multivariate models, vulvitis, genital ulcer disease, vaginal discharge, and Candida vaginitis were significantly associated with HIV-1 seroconversion. Women who used depo medroxyprogesterone acetate (DMPA) had an increased incidence of HIV-1 infection (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.4-3.4). In a multivariate model controlling for demographic and exposure variables and biologic covariates, the adjusted HR for HIV-1 infection among DMPA users was 2.0 (CI, 1.3-3.1). There was a trend for an association between use of high-dose oral contraceptive pills and HIV-1 acquisition (HR, 2.6; CI, 0.8-8.5).
authors.affiliation: Department of Medicine, University of Washington, Seattle 98104-2499, USA.
authors.forename: H L
authors.initials: HL
authors.lastname: Martin
authors.forename: P M
authors.initials: PM
authors.lastname: Nyange
authors.forename: B A
authors.initials: BA
authors.lastname: Richardson
authors.forename: L
authors.initials: L
authors.lastname: Lavreys
authors.forename: K
authors.initials: K
authors.lastname: Mandaliya
authors.forename: D J
authors.initials: DJ
authors.lastname: Jackson
authors.forename: J O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: J
authors.initials: J
authors.lastname: Kreiss
mesh_terms: D001519:Behavior; D002181:Candidiasis, Vulvovaginal; D003267:Contraception; D003271:Contraceptive Agents, Female; D003273:Contraceptive Devices; D003710:Demography; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D007630:Kenya; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology*; D014456:Ulcer; D019522:Vaginal Discharge; D014847:Vulvitis
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate