title: Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012.
abstract: Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting.
  
  
  
  Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M-F+) was evaluated.
  
  
  
  Among 1601 M-F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5-6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI, .4-1.2), oral contraceptive pill (aHR, 0.8; 95% CI, .3-2.1), nor implant (aHR, 0.8; 95% CI, .5-1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions.
  
  
  
  Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples.
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Department of Epidemiology, Rollins School of Public Health and Laney Graduate School.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health.
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Department of Gynecology and Obstetrics, School of Medicine, University of Zambia.
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.affiliation: Department of Epidemiology, Rollins School of Public Health and Laney Graduate School.
authors.forename: Preeti
authors.initials: P
authors.lastname: Ravindhran
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health.
authors.forename: Naw Htee
authors.initials: NH
authors.lastname: Khu
authors.affiliation: Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham.
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.affiliation: Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, New York.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Johnson
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Haddad
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health.
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D018562:Disease Transmission, Infectious; D004363:Drug Utilization; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D018570:Risk Assessment; D015024:Zambia
chemical_list: D003278:Contraceptives, Oral, Hormonal
keywords: HIV discordant couples; HIV risk; Zambia; hormonal contraception; longitudinal cohort