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      Hormonal contraception, sexual behaviour and HIV prevalence among women in Cameroon

      research-article
      Author(s): 1 , , 2 , 3
      Publication date (Electronic):
      Journal: BMC Women's Health
      Publisher: BioMed Central

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          Abstract

          Background

          Data on the effect of contraceptive methods, other than the condom, on HIV acquisition is not clear. The aim of this study was to describe hormonal contraceptive use, sexual behaviour and HIV prevalence among women in Cameroon in order to provide baseline information for future analytical studies.

          Methods

          This is a cross-sectional descriptive study based a nationally representative sample of 4486 sexually active women aged 15–49 years who participated in the 2004 Cameroon Demographic and Health Survey.

          Results

          The overall HIV prevalence was 7.4% (332/4486). The HIV prevalence was higher in the 25–35 year age group (10.03%), urban residents (9.39%), and formerly married (18.48%), compared to their compatriots. The prevalence was lower in women with five or more living child (3.67%), women in the low wealth index category (3.79%) and women who had no formal education (3.37%). The HIV prevalence was higher among women who had two or more partners in the last 12 months (10.26%) and women who reported to have had four or more partners in their lifetime (12.40%). The prevalence of HIV was higher among current hormonal contraceptive users (6.63%) compared to the current non-users (3.06%), among ever users of hormonal contraception (13.27%) compared to the never users (7.11%).

          Conclusion

          We conclude that the prevalence of HIV among sexually active women in Cameroon varies according to sociodemographic characteristics, sexual behaviour and hormonal contraceptive use. Our findings underscore the need to counsel women using hormonal contraception to be aware that hormonal methods do not protect against HIV infection. Given the biologic plausibility of the link between hormonal contraception and HIV infection, future research should focus on carefully designed prospective studies to establish the temporal relationship and estimate the incidence of HIV infection among women using and not using hormonal contraceptive methods.

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          Most cited references20

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          Hormonal contraception and the risk of HIV acquisition.

          Charles Morrison, Barbra Richardson, Francis A Mmiro … (2007)
          Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18-35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases). HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69-1.42] nor DMPA (HR, 1.25; 95% CI, 0.89-1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39-5.82) and DMPA (HR, 3.97; 95% CI, 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding.
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            Trends in antenatal HIV prevalence in urban Uganda associated with uptake of preventive sexual behaviour.

            R Bessinger, P Ghys, J Musinguzi … (2006)
            Epidemiological surveillance in Uganda has consistently shown declining HIV prevalence particularly among young antenatal women since the early 1990s, correlated with increased uptake of protective sexual behaviour. To describe trends in sexual behaviour nationwide and antenatal HIV prevalence from urban sentinel sites in Uganda (1989-2002). Review of antenatal HIV seroprevalence data from the sentinel surveillance system (1989-2002) and data on sexual behavioural indicators from the AIDS module of the National Demographic and Health Surveys (1989, 1995 and 2000/01). Trends in biological and behavioural indicators assessed. Antenatal HIV seroprevalence in seven urban clinics peaked around 1992 (15-30%) followed by a steady decline by 2002 (5-12%), most markedly among women aged 15-19 and 20-24 years. This coincided with increased primary and secondary abstinence among young people nationwide. Median age at sexual debut increased from 16.5 in 1989 to 17.3 in 2000 for women and from 17.6 in 1995 to 18.3 in 2000 for men. Premarital sex among women and multiple partnerships decreased between 1995 and 2000. There were no significant changes in reporting of extramarital sex among men. Ever use of condoms increased from 1% among women in 1989 and 16% among men in 1995 to 16% and 40% in 2000, respectively. Between 1995 and 2000, condom use at last sex with a non-regular partner increased from 35% to 59% and 20% to 39% among men and women, respectively. The ecological correlation between the trends in HIV prevalence and incidence and the increase in protective sexual behaviour during the 1990s makes a compelling case for continuing prevention efforts in Uganda.
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              Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda.

              Damien de Walque, June Busingye, Alexander J. Whitworth … (2005)
              Previous studies have found that in Africa, a greater risk of HIV infection is often found in groups with higher educational attainment. However, some serial cross-sectional studies have found greater reductions in HIV prevalence among more educated groups, especially in cohorts of young adults. More recent studies have found some instances where higher schooling levels are associated with lower HIV prevalence. We describe changes in the association between schooling levels, HIV prevalence and condom use in a rural population-based cohort between 1989/1990 and 1999/2000, in Masaka District, Uganda. In 1989-1990, higher educational attainment was associated with higher risk of HIV-1 infection, especially among males, but once odds ratios are adjusted for age, no significant relation between schooling and HIV infection remains. In 1999-2000, there is, for females aged 18-29 years, a significant relationship between higher educational attainment and lower HIV prevalence, even after adjustment for age, gender, marital status and wealth (P for trend 0.01). Tests for interaction, significant for males and both genders combined, show that more schooling has been shifting towards an association with less HIV infection between 1989-1990 and 1999-2000, especially for young individuals. Condom use increased during the study period and this increase has been concentrated among more educated individuals. These findings suggest that over a decade more educated young adults, especially females, have become more likely to respond to HIV/AIDS information and prevention campaigns by effectively reducing their sexual risk behaviour.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Womens Health
                Title: BMC Women's Health
                Publisher: BioMed Central
                ISSN (Electronic): 1472-6874
                Publication date Collection: 2008
                Publication date (Electronic): 30 October 2008
                Volume: 8
                Page: 19
                Affiliations
                [1 ]Child and Reproductive Health Group, Liverpool School of Tropical Medicine, UK
                [2 ]School of Social Work, Bar-Ilan 2 University, Ramat-Gan, Israel
                [3 ]Braun School of Public Health, Hadassah – Hebrew University, Jerusalem, Israel
                Article
                Publisher ID: 1472-6874-8-19
                DOI: 10.1186/1472-6874-8-19
                PMC ID: 2584627
                PubMed ID: 18973697
                SO-VID: f0a54054-167f-4723-8d9f-434ca2611396
                Copyright © Copyright © 2008 Kongnyuy et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 April 2008
                Date accepted : 30 October 2008
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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