Hormonal contraception, sexually transmitted diseases, and risk of heterosexual transmission of human immunodeficiency virus type 1.
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).
Martin
H L
HL
Department of Medicine, University of Washington, Seattle 98104-2499, USA.
Nyange
P M
PM
Richardson
B A
BA
Lavreys
L
L
Mandaliya
K
K
Jackson
D J
DJ
Ndinya-Achola
J O
JO
Kreiss
J
J
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
D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate