African women need greater contraceptive choices, Aids conference hears

South African Aids activist Yvette Raphael has told a panel at the ninth South African Aids Conference that African women need greater choices when it comes to contraceptives.

Raphael was speaking at the Inkosi Albert Luthuli International Convention Centre in Durban on Thursday following the official release of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study.

The study compared three different types of contraceptives and the possibility that one of them – the DMPA progestin injection, known as Depo-Provera – increased the risk of HIV infection among women.

The potential risk of the DMPA injection has long been uncertain, which led to the US$50 million study.

ECHO started in 2015, with trials eventually taking place on 7,830 HIV negative women between the ages of 16 and 35, who wanted to be placed on contraception, in South Africa, Kenya, Eswatini and Zambia.

The women had the choice of using Depo, the LNG arm implant or copper IUD for the study.

The results indicated that there was no evidence to suggest that women who used Depo were at a greater risk of contracting HIV than women who used the other contraceptives.

Raphael, who heads the group Advocates for the Prevention of HIV in Africa (APHA), said it was good that the question about the safety of the injection had been answered.

However, she said, this did not mean the injection should be the dominant contraceptive choice for women in eastern and southern Africa – areas with high rates of HIV/Aids infection.

“We don’t believe that Depo should continue to be the only long-acting method available for too many black women and brown women across the world,” said Raphael.

“The ECHO study shows the method mix is possible. We have heard the scientists saying women love Depo. It’s not true. This trial has shown us that women, if randomised, if given a choice, will maybe not choose Depo. So Depo is not our favourite method.”

Earlier, Dr Yogan Pillay of the South African Department of Health had said more than 6.2 million doses of Depo were used in the last financial year.

He said 4.2 million doses of oral contraceptives were given, 51,000 IUDs were inserted and 213,000 implants inserted. “So you can see that [Depo] is a method of choice for a significant number of women in our country,” Pillay said.

But Raphael said it was common knowledge that when women went to clinics seeking contraceptives, they were not given a choice. “It’s only Depo or the pill. That is not a choice – the choice is when I am given all methods to choose from and I can choose.”

Raphael said activists were watching how the South African government was spending money that was meant for contraceptives. “[We are also] watching how women are treated in clinics, so for us, the fight continues.”

African News Agency (ANA)

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