PRI Weekly Briefing
A new report has appeared indicating that the injectable contraceptive Depo Provera can triple the risk of contracting a sexually transmitted disease (STD). This raises a very disturbing question: Has the West, by shipping tens of millions of doses of Depo Provera to Africa and other parts of the developing world, been facilitating the spread of AIDS and other STDs?
PRI says yes. :O
Steven W. Mosher
Population Research Institute
September 8, 2004
PRI Weekly Briefing
7 September 2004
Vol. 6 / No. 29
Media Reports: Depo Provera Is Hazardous to your Health
The headlines were surprising, although the news was not:
USA Today: "Contraceptive is linked to high STD risk" (1)
MSNBC/Reuters: "Contraceptive may triple STD risk; Study: Depo Provera increases chance of chlamydia, gonorrhea" (2)
WebMD: "Depo Provera May Raise STD Risks: Injectable Contraceptive Linked to Higher Chlamydia and Gonorrhea Risk" (3)
The stories were based on a study published the September issue of "The Journal of the American Sexually Transmitted Disease Association" (4), reported in press releases from Family Health International, (5) and the National Institutes of Health (NIH). According to the NIH, the study found:
"The injectable contraceptive depot-medroxyprogesterone acetate (DMPA) appears to increase a woman's risk of acquiring the sexually transmitted infections chlamydia and gonorrhea by approximately three fold when compared to women not using a hormonal contraceptive, according to a study jointly funded by the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health and the U.S. Agency for International Development's Office of Population and Reproductive Health. (6)
Depo-Provera is the name under which DMPA is marketed. Injected into the arm or buttocks four times a year, the drug works by inhibiting ovulation and, when breakthrough ovulation and conception occurs, implantation.
Why does Depo-Provera increase the risk of STDs? "The study was unable to identify the means by which DMPA might increase the risk for chlamydial or gonococcal infection,"(7) according to Joanne Luoto, M.D., of NICHD's Contraception and Reproductive Health Branch.
But surely this is no mystery. For some time it has been suspected that use of any progesterone-based approach to contraception, from Norplant and Depo-Provera, to various kinds of birth control pills, increases the risk of contracting STDs, including deadly HIV/AIDS virus. A 1996 study conducted by researchers at the Aaron Diamond AIDS Research Center in New York and supported by the World Health Organization found an elevated HIV infection rate among monkeys who were given subdermal progesterone implants. The study also found that the vaginal epithelia - the lining of the vagina - of the monkeys with the implants were "significantly reduced." The Aaron Diamond Study confirms that the presence of progesterone thins the vaginal wall, thus making it far more vulnerable to abrasions and infection by STDs or HIV during intercourse.
This new research has sobering implications for the AIDS epidemic in Africa and our role in it. The U.S. foreign aid establishment would sooner eat ground glass than admit it, but it is very likely that our family planning programs have been aiding the spread of the HIV virus.
From 1994-2000, USAID provided 41,967,200 units of Depo-Provera into the developing world, at a cost of over $40 million.(8 ) An even larger source of Depo-Provera is the UNFPA, which boasts of being the largest supplier of contraceptives in the world. In the nineties, when it was receiving funding from the Clinton administration, the UNFPA was shipping 20 million doses of Depo-Provera out the door a year.(9)
The lion's share of these shipments was and is bound for Africa.Depo-Provera is a major component of foreign-funded family planning programs in Africa. USAID sends more units of Depo-Provera to Africa, to countries such as Mozambique, Tanzania and Nigeria, than to any other part of the world. Although the UNFPA is less transparent about the destination of its contraceptive shipments, it does admit to spending more money on its African programs than elsewhere. Once in Africa, the Depo-Provera is handed out under "social marketing" schemes to virtually any woman who will agree to take it. Women are expected to inject themselves with the drug, and are given no medical advice or counseling whatsoever.
The bottom line? As the HIV/AIDS epidemic in Africa rages out of control, we have been recklessly promoting and distributing drugs which make women even more vulnerable to the deadly virus. We have been pouring gasoline on a fire.
May God forgive us.
1. USA Today; 8/22/04;
2. MSNBC/Reuters; 8/23/04; http://msnbc.msn.com/id/5796331
4. The Journal of the American Sexually Transmitted Disease Association, September 2004; http://www.stdjournal.com.
5. Family Health International; "Depo Provera Appears to Increase Risk for Chlamydial and Gonococcal Infections;" 8/23/04
6. NIH Press Release; "Depo Provera Appears to Increase Risk for Chlamydial and Gonococcal Infections;"
8. Numbers are from the Population, Health and Nutrition Projects Database (PPD), http://ppd.phnip.com. PPD is a computer-based information system managed by the Population, Health, and Nutrition Information Project on behalf of USAID's Center for Population, Health and Nutrition. See also PRI Review, January-February 2003, 13(1), 5.
9."New Era for Injectables," Population Reports, 23(2), August 1995. Like most UN agencies, the UNFPA is extremely secretive about its operations. According to Population Reports, DMPA (Depo-Provera, Megastron) makes up three-quarters of UNFPA shipments of injectables, and NET EN (another injectable contraceptive) one-quarter. Thus in 1994 UNFPA shipped enough injectables for about 4.6 million woman-years of use. Deliveries of DMPA by the International Planned Parenthood Federation increased from 336,000 doses in 1991 to 735,000 in 1994. Deliveries of NET EN increased from 305,000 in 1991 to 438,000 in 1994. It is unclear whether the UNFPA, International Planned Parenthood Federation (IPPF), or other suppliers ship only single-dose vials, with an equal number of syringes and needles, or whether they sometimes provide the drug to end-users as multi-dose vials, with the associated risk of contamination and HIV transmission that reusing the vials entails.
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