Contraceptives Versus HIV, Are Nigerians Ready for ECHO?

The global hot discourse is  shifted to Contraceptives Versus HIV and the ECHO Result.

On Thursday, June 13, the much expected results of Evidence for Contraceptives Options and HIV Outcomes (ECHO) would be known.

All around the world the pulse is heightened to know what relationship is between some contraceptives and risk of HIV infection. But are Nigerians ready for the outcome of the  ECHO study?

The ECHO Study was designed to assess three highly effective, reversible long-acting contraceptive methods: the progestogen-only contraceptive depot medroxyprogesterone acetate (DMPA) also known as “Depo”, the Jadelle subdermal implant and the copper intrauterine device (IUD). All of these contraceptive methods are commonly used because they do not interfere with sex.

Prof. Elly Katabira

For nearly twenty-five years it has been controversy over whether certain long lasting contraceptives increase the risk of becoming infected with HIV and so there is increasing call that these contraceptives should be discontinued.

There is no denying the fact that in many countries of the sub-Sahara especially Nigeria, contraceptive prevalence rates (CPR) are quite low. Nigeria for example has a CPR of about 15% as at 2018 and is struggling to reach 16% of the women reproductive age population which is about 23% of the total 49% women population in the country’s 180m.

At the recently held 13th International Conference on HIV Treatment, Pathogens, And Prevention Research in Resource – Limited Settings known as INTEREST CONFERENCE 2019 in Accra, Ghana,  experts raise concern over the burden of rising population in Africa with renewed fears around Contraceptives versus HIV amidst dwindling resources from across the world.

There is a renewed concern on achieving sustained economic development and growth as the world aims at reaching the target of Family Planning 2020 as articulated in the Sustainable Development Goals SDGs.

Scientists at INTEREST Conference called for consciousness among African leaders to fund the unmet needs for Family Planning and check population on the continent; also look into additional methods to bridle the need for double protection in women of reproductive age group who are sexually active but do not want to get pregnant against HIV infections.

This is in the event that the ECHO result indicts any contraceptives versus  HIV infection among its users.

Speaking with HEALTHSTYLEPLUS in Accra, Co-Chair of the Conference, Professor Elly Katabira of the Makerere University College of Health Sciences, Uganda, “we in Africa have really reached a crossroad wherein we must be open to ourselves on the Continent on issues of Sexual and Reproductive Health and Rights (SRHR)”.

Katabira who was the foremost Clinician to open an HIV Clinic in Africa in the early years of the disease noted, “issues of Contraceptives must be well discussed and women in Africa must be encouraged to openly agree to be on contraception to enhance their lives, yet if there are risks to health, government must invest in alternatives to protect the women population especially from HIV”.

According to Katabira, “Choices of contraceptives would really be enhanced especially among key populations where there is openness about SRHR and sexuality as well as around issues of HIV/AIDS and contraception.

“Nigeria still has a lot around culture of silence and denial but Uganda couldn’t afford to continue to deny where we are and so we deliberately adopted the policy of openness as a precursor to self-test for HIV. Where anyone is in doubt of any contraceptive choice, our policy permits such individuals to walk into our public health facilities to ask for help”, said Katabira.

According to Nigeria’s Professor Sulaiman Akanmu of The President’s Emergency Plan For AIDS Relief (PEPFAR), United States governmental initiative to address the global HIV/AIDS epidemic and Consultant Hematologist, Lagos University Teaching Hospital (LUTH), “should there be need any form of indictment on any of the popular Contraceptive methods involved in the study, Nigerian government will only need to increase her funding of Contraceptives to include the Pre-Exposure Prophylaxis (PrEP) which is already available only not widely accepted”, said Akanmu.

Echo Trial Result on Hormonal Contraception and HIV

“In principle, PrEP is another level of protection to ensure no new infection occurs”, says Akanmu.

He explained, “ PrEP is simply an attempt to use antiretroviral drug to prevent individuals who are not currently infected from becoming infected. It is taking treatment as a form of prevention. In other words, one is taking HIV drugs as a form of infection like someone who has infection because you have practices that exposes you to risk that could make you acquire it. The drug prevents the user from acquiring the infection peradventure he or she is eventually exposed”.

Prof. Joseph Otubu

But for Family Planning expert and Professor of Reproductive Health and Infertility Joseph Otubu, who is the outgoing Vice-President of Christian Association of Nigeria, “As Nigerians, we should be looking at three things that may be important before discussing the echo result: First, our contraceptives prevalence is still very low. Secondly, unmet needs for contraceptives is very high and third, the choices that are available to us are not wide enough. That is why it (ECHO) should be a concern to everybody.

“Nigeria is currently faced with high unmet needs for contraceptives amidst myths and misconceptions and if the already little achievement is shaken by some ill-advised information on contraceptives versu HIV, the backlash would be very terrible”, warned Otubu.

He is worried that the government may be faced with communicating the situation to Nigerian women should there be any form of indictment.

“However, if we are faced with making a choice that’s probably the circumstance, then we should say to people, this are what we have available as preventable measures which can now be used along with Depo.
“The country should be made then to see the urgency to buy into the prep. The thought of withdrawing depo is frightening.

BACKGROUND TO ECHO STUDY:

Over the past 25 years, as the HIV epidemic has spread, a number of observational studies were undertaken to explore whether or not the use of contraceptive methods increases the risk of HIV acquisition.

No association between combined hormonal contraceptive methods—which include the use of two hormones (estrogen and progestogen) to prevent pregnancy from occurring—and HIV acquisition has been shown. Few studies have examined whether hormonal implants or intrauterine devices (IUDs) affect users’ risk of HIV acquisition.

Some studies suggest increased risk of HIV acquisition among users of DMPA. Data from recent studies included in the latest systematic review strengthen concerns about a possible increased risk of HIV acquisition associated with DMPA use. After reviewing the evidence, a WHO technical consultation concluded in March 2017 that the available evidence continues to indicate an association between use of progestogen injectables and an increased risk of acquiring HIV; however, it is unknown whether the associations seen in these observational studies were due to a true biological effect or the limitations of such studies

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