Birth control counseling may reduce AIDS transmission in Africa, say researchers

July 26, 2012

Family planning counseling could prove to be a cost-effective way to help minimize the number of children born HIV-positive in sub-Saharan Africa, a new study by School of Medicine researchers suggests.

"If you can help prevent HIV-positive women from having unplanned children, obviously you're going to prevent unnecessary ," said Clea Sarnquist, DrPH, MPH, a senior research scholar in pediatrics at Stanford and first author of the new study, which was presented today at the International AIDS Conference in Washington, D.C.

According to Sarnquist and her colleagues, about 40 percent of pregnancies in sub-Saharan Africa are unplanned. Such could be prevented if women relied on long-acting forms of — such as the intra-uterine device, or IUD, or hormonal implants — rather than birth control pills or diaphragms. Indeed, the researchers found that after receiving group counseling almost 90 percent of the HIV-positive women in the study chose a long-acting form of contraception.

The women in the study, which was conducted in a suburban region of Zimbabwe, also said they felt a greater sense of power in negotiating sexual activity, including condom use, and were more open with their partners about their HIV status, the researchers reported.

Every year, hundreds of thousands of babies are born HIV-positive in sub-Saharan Africa. While there are medications that can prevent transmission of the virus during pregnancy or breastfeeding, many of the women are unable to get them. In Zimbabwe, for instance, fewer than half of all HIV-positive women who are pregnant have access to these medications, though the numbers have been on the rise in recent years, Sarnquist said.

By contrast, studies have shown that providing counseling is more cost-effective than providing anti-AIDS medications; according to one study, annual cost savings to prevent unwanted births ranged from $26,000 in Vietnam to more than $2.2 million in South Africa. Moreover, family planning has other benefits that help improve women's overall health and well-being, Sarnquist said. For maximum prevention, both drugs and counseling should be available, she added.

In the study, Sarnquist and her colleagues worked with a group of 98 HIV-positive women in the village of Chitungwiza, about 30 miles from the Zimbabwean capital of Harare. Yvonne Maldonado, MD, professor of at Stanford and senior author of the study, has established a study site there and done research over the last two decades on preventing HIV transmission from mother to child. About 16 percent of the women in Chitungwiza are HIV-positive.

The researchers invited two-thirds of the study participants, all of whom had recently given birth, to attend three 90-minute group sessions with trained counselors. The women learned about family planning, sexual negotiation and HIV prevention and did exercises in self-esteem building and communication. The other one-third served as a control group, receiving the standard information on family planning.

The majority of the women in the region use the pill for contraception, which isn't consistently reliable as women are not always able to get to the clinic for drug refills or to afford purchasing them even if they can get there, Sarnquist said. In the sessions, the women were introduced to implants and intrauterine devices, which can protect against pregnancy for three to 10 years, depending on the device.  Fifteen nurses also were trained to install IUDs and implants, matchstick-sized cylinders that are inserted under a woman's arm and secrete hormones into the bloodstream.

Within three months, almost 90 percent of the women had opted for either the implants or IUDs, up from 13.5 percent that had used them previously, the researchers reported.
"The implants were extremely popular, which we didn't necessarily expect," Sarnquist said.
Because implants provide highly effective pregnancy prevention for four to five years, it could help women prevent unplanned pregnancies during that time. The World Health Organization recommends that women wait at least two years between pregnancies. For HIV-positive women, this spacing allows women an opportunity to maximize their own health and reduce the amount of virus in their system, which decreases the risk of passing the virus on to their unborn children, Sarnquist said.

In the study, the women were also far more inclined to talk to their partners about their HIV status, likely because of improved communication and knowledge about HIV, Sarnquist said.

"That was an unexpected finding, which does have ramifications for HIV transmission and stigma," she said.

In addition, the women in the counseling group reported feeling more power in their relationships, particularly with regard to negotiating sexual activity. For instance, more of the women felt they were able to persuade their partners to use condoms or to talk about condom use, Sarnquist said.

Sarnquist said the researchers are hoping to expand the study to a much larger population of women who could be followed over a longer period of time, with a goal of determining whether the approach can reduce the number of unplanned pregnancies, and in turn, the number of children born -positive.

The approach could be easily replicated in other regions of sub-Saharan Africa to reach many more , she said.

Researchers from the University of Zimbabwe-UCSF Collaborative Research Programme joined in conducting the study. Jennifer Kang, MPH, the former project manager, was also involved in the study.

The work was supported by U.S. President's Emergency Plan for Relief and the National Institutes of Health.

Explore further: Study in Lancet finds use of hormonal contraception doubles HIV risk

Related Stories

Study in Lancet finds use of hormonal contraception doubles HIV risk

October 3, 2011
Women using hormonal contraception --such as a birth control pill or a shot like Depo-Provera – are at double the risk of acquiring HIV, and HIV-infected women who use hormonal contraception have twice the risk of transmitting ...

Fighting HIV in South Africa should focus on couples, study finds

April 25, 2011
A new study of sexual risk behaviors within long-term couples in South Africa finds that HIV-positive people take almost as much risk in their sexual behavior when they know their partner is HIV-negative or don't know their ...

Intrauterine devices, implants most effective birth control

May 23, 2012
A study to evaluate birth control methods has found dramatic differences in their effectiveness. Women who used birth control pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than ...

Recommended for you

Study suggests a way to stop HIV in its tracks

December 1, 2017
When HIV-1 infects an immune cell, the virus travels to the nucleus so quickly there's not enough time to set off the cell's alarm system.

Discovery puts the brakes on HIV's ability to infect

November 30, 2017
Viewed with a microscope, the virus faintly resembles a pineapple—the universal symbol of welcome. But HIV, the virus that causes AIDS, is anything but that. It has claimed the lives of more than 35 million people so far.

Rising levels of HIV drug resistance

November 30, 2017
HIV drug resistance is approaching and exceeding 10% in people living with HIV who are about to initiate or reinitiate first-line antiretroviral therapy, according to the largest meta-analysis to date on HIV drug resistance, ...

Male circumcision and antiviral drugs appear to sharply reduce HIV infection rate

November 29, 2017
A steep drop in the local incidence of new HIV infections accompanied the rollout of a U.S.-funded anti-HIV program in a large East-African population, according to a study led by researchers at Johns Hopkins Bloomberg School ...

Combination HIV prevention reduces new infections by 42 percent in Ugandan district

November 29, 2017
A study published today in the New England Journal of Medicine provides real-world evidence that implementing a combination of proven HIV prevention measures across communities can substantially reduce new HIV infections ...

Research on HIV viral load urges updates to WHO therapy guidelines

November 24, 2017
A large cohort study in South Africa has revealed that that low-level viraemia (LLV) in HIV-positive patients who are receiving antiretroviral treatment (ART) is an important risk factor for treatment failure.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.