ECHO-ing debates: Ongoing advocacy related to hormonal contraception and HIV

October 2, 2014

On October 1, advocates, researchers and policy makers from all over the world participated in an AVAC-hosted webinar, Data and Uncertainty, that featured three presentations related to the possible linkages between hormonal contraception and risk of HIV acquisition. The presentations and audio can be reviewed here.

This webinar was one of many forums where this topic has been discussed and debated in recent weeks. In separate efforts, coalitions of South African- and US-based advocacy groups have called for full funding of the ECHO trial that is designed to evaluate the possible relationship between three different contraceptive methods and women’s risk of acquiring HIV. AIDS Legal Network, ATHENA Network, AVAC, the International Community of Women Living with HIV/AIDS, Pangaea Zimbabwe AIDS Trust and other advocates had previously released an editorial explaining the need to fund ECHO as part of a comprehensive approach to truly effective HIV and sexual/reproductive health programs.

The South African “solidarity statement” was launched by the South African HIV Prevention Research Expert Group—a coalition that includes the AIDS Accountability International, AIDS Legal Netwok, Centre for HIV & Prevention Studies, Desmond Tutu HIV Foundation, the Graca Machel Trust and Sonke Gender Justice. Addressed to South Africa’s Minister of Health, the head of the South African National AIDS Council, and the head of the Medical Research Council, it states, in part,

We the undersigned therefore stand in solidarity with the women of South Africa, one of the Sub Saharan countries with the widest use of depot medroxyprogesterone acetate (DMPA), in encouraging our Department of Health, the Medical Research Council, and the South African National AIDS Council to ensure that the ECHO trial is fully funded – as a national imperative, especially as a country whose response to and recent leadership in the national response to HIV is world renowned.

The US-based consensus statement, which was launched on October 1, is addressed to leaders at the National Institutes of Health. It calls on the NIH to “make a strong financial commitment to ECHO in 2014, and thus enable this trial to proceed in 2015 without delay.” Signatories are currently being sought to join the Black Women’s Health Imperative, SisterSong, SisterLove and the National Women’s Health Network.

There are, of course, many views on the broad range of issues related to integration of HIV and family planning—and to questions related to HIV risk and specific methods. There is also a great deal of focused debate regarding the need, merits and feasibility of the trial specifically. One area of broad agreement is that there is a need to expand the range of contraceptive methods available to all women and to provide women with clear, accurate information about the risks and benefits of various methods—and of unintended pregnancy—to support informed choice. However, the details the strategy for achieving these goals are less clear.

In terms of the actual trial, one of the striking aspects of the discussion is that some stakeholders who argue that it is not the best use of resources do so because they feel that there is already too much evidence linking Depo and HIV; others argue that the evidence is such that it doesn’t warrant further investment via a trial like ECHO. A series of editorials on this topic were published in the current issue of the journal Contraception that also featured the most recent systematic review of epidemiological evidence. The editorials are not open access, while the review is. Two additional commentaries arguing against the proposed trial are Living with Uncertainty: Acting in the Best Interests of Women by Erica Gollub and Zena Stein and Next steps for research on hormonal contraception and HIV by Lauren Ralph and colleagues.

AVAC is eager to continue to engage in these essential debates and discussions. If you want or have resources, questions or viewpoints you would like to share, please let us know—and stay involved!