OA20.06
Background: The association between hormonal contraception (HC) use and risk of both male-to-female and female-to-male transmission HIV transmission is highly debated. Very little data exists related to female-to-male transmission risk and HC use. USAID, FHI360, and the World Health Organization have called for more evaluations of this association.
Methods: HIV discordant couples in which the man was negative and the woman was positive (M-F+) were identified after couples' voluntary HIV counseling and testing from 1995–2012 in Lusaka, Zambia. Discordant couples were followed longitudinally and demographic, behavioral, clinical, and family planning measures were collected at baseline and 3-monthly. Men were re-tested for HIV every three months. Multivariate Cox models evaluated time to HIV acquisition among men.
Results: Among 1654 M-F+couples, 226 incident infections occurred over 3366 couple-years (6.71/100 couple-years; 95%CI: 5.87-7.65). 171 (76%) infections were genetically linked to the study partner. No interaction between genital ulceration/inflammation and contraception was observed. Use of injectables (HR=0.7; 95%CI:0.4-1.4), OCPs (HR=1.3; 95%CI:0.7-2.1), or implants (HR=0.8; 95%CI:0.2-2.8) in the past three months was not associated with genetically linked HIV transmission from women to men relative to non-HC controlling for: woman's age, number of previous pregnancies, woman's log viral load at baseline, male circumcision status, pregnancy status, sex frequency with and without a condom, sperm on a wet mount, male and female genital inflammation and ulceration, and time interval since enrollment.
Conclusions: Our results add to a small and inconclusive body of literature. Over 17 years of follow-up, we found no statistically significant association between HC use and female-to-male HIV transmission. These findings support the continued use of HC methods for pregnancy prevention and Prong 2 of PMTCT.
