Behavioral effects of different contraceptive methods and HIV acquisition: an ancillary study of the ECHO randomized trial

Abstract

Plain Language Summary There have been concerns that the depot-medroxyprogesterone acetate injection (DMPA-IM) may increase the risk of getting HIV infection. However, a large multicenter randomized study, the ECHO trial, recently compared HIV incidence among women randomized to DMPA-IM, the copper intrauterine device (IUD) and the levonorgestrel (LNG) implant and found little difference in HIV risk between these methods. DMPA-IM often causes no or scanty menstruation; we hypothesized that this may have a protective effect on getting HIV, by reducing exposure to HIV during menstrual bleeding. This ancillary study was done among ECHO trial participants at one of the ECHO study sites in South Africa. The aim was to assess the effects of the three different contraceptives on menstrual symptoms and sexual behavior and to correlate these with the risk of getting HIV. The study required women to complete a 28-day daily symptom and behavior diary after their one-month ECHO trial follow-up visit. We found that fewer women had sex during their periods with DMPA-IM and the LNG implant than the copper IUD, probably because no or scanty menstruation is more common with both DMPA-IM and the implant. Although effects were not statistically significant, having sex during periods tended to have a higher risk of getting HIV and longer periods indicated a lower risk of getting HIV. We concluded that sexual behavior related to menstruation may influence HIV acquisition and may partially explain why the ECHO trial found little difference in HIV incidence between the three contraceptives assessed despite observational evidence of higher biological risk with DMPA related to immune suppression.

Keywords

• Contraception
• HIV
• Sexual behavior
• DMPA
• Intrauterine device
• LNG implant