title: Hormonal contraceptive use and women's risk of HIV acquisition: priorities emerging from recent data.
abstract: OBJECTIVE
  Understanding whether hormonal contraception increases women's risk of HIV acquisition is a public health priority. This review summarizes recent epidemiologic and biologic data, and considers the implications of new evidence on research and programmatic efforts.
  
  
  RESULTS
  Two secondary analyses of HIV prevention trials demonstrated increased HIV risk among depot medroxyprogesterone acetate (DMPA) users compared with nonhormonal/no method users and norethisterone enanthate (NET-EN) users. A study of women in serodiscordant partnerships found no significant association for DMPA or implants. Two meta-analyses found elevated risks of HIV among DMPA users compared with nonhormonal/no method users, with no association for NET-EN or combined oral contraceptive pills. In-vitro and animal model studies identified plausible biological mechanisms by which progestin exposure could increase risk of HIV, depending on the type and dose of progestin, but such mechanisms have not been definitively observed in humans.
  
  
  CONCLUSIONS
  Recent epidemiologic and biologic evidence on hormonal contraception and HIV suggests a harmful profile for DMPA but not combined oral contraceptives. In limited data, NET-EN appears safer than DMPA. More research is needed on other progestin-based methods, especially implants and Sayana Press. Future priorities include updating modeling studies with new pooled estimates, continued basic science to understand biological mechanisms, expanding contraceptive choice, and identifying effective ways to promote dual method use.
authors.affiliation: aDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California bDepartment of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida cCUNY School of Public Health and Hunter College, New York, New York, USA.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Ralph
authors.forename: Erica L
authors.initials: EL
authors.lastname: Gollub
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Jones
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006292:Health Priorities; D006801:Humans; D015994:Incidence; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011634:Public Health; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate; C024319:norethindrone enanthate; D009640:Norethindrone