Birth Control and HIV

Hormonal Birth Control and HIV AIDS

One of the standard warnings given to women who choose to use hormonal birth control methods such as the birth control pill is that while these contraceptives may help prevent pregnancy, they do not provide protection against sexually transmitted diseases (STDs) such as HIV/AIDS. Recent studies have suggested that the risk of HIV transmission among women using hormonal birth control methods is actually increased. Furthermore, the reasons behind this increased risk of HIV/AIDS transmission among women using birth control goes beyond the fact that hormonal contraception does not provide STD protection. So how does hormonal birth control increase the risk of HIV/AIDS?

HIV AIDS Transmission

In order for the HIV virus to be transmitted, there must be a point of access within the body where the infection may take place such as an open sore, a needle prick, a bleeding surface, inflammation or an otherwise fragile surface. Some studies suggest that the side effects associated with sex hormones that are used in hormonal birth control methods may increase the likelihood of these types of infection sites to occur.

Types of Hormonal Contraceptives

A report published by the International AIDS Society has linked the use of an injectable contraceptive known as depot medroxyprogesterone acetate (DMPA) with an increased risk of HIV-1 infections. Interestingly, women using DMPA were at a greater risk of HIV infection than women using no form of contraception at all.

In addition, the same study suggested that there may be a link between HIV infection and oral contraceptives or birth control pills.

Birth Control Pills and HIV

The hormones that are used in birth control pills can produce a variety of effects on the female reproductive system. Some explanations as to how this hormonal birth control method may increase the risk of HIV/AIDS transmission include the following.

Irregular Bleeding
All types of hormonal birth control methods cause irregular uterine bleeding and produce common birth control symptoms such as "spotting" or "breakthrough bleeding." Breakthrough bleeding is typically caused by an excessive thickening of the lining of the uterus (endometrium).

The effects of hormonal birth control on the endometrium make it an ideal site of infection, since the uterine lining becomes a large, bleeding surface where HIV transmission may take place. In addition, the presence of blood in the vagina may change the pH in the area, and make it more susceptible to HIV and STD infections.

The presence of blood in the vagina also increases bidirectional HIV transmission (i.e. from men to women and vice versa). This is because the HIV virus is found in highest concentrations in the blood.

Cervical Ectopy
Hormonal birth control causes cervical ectopy - a condition in which a layer of endo-cervical cells extends beyond the opening of the cervix. This fragile layer of cells replaces a thick membrane that is comprised of multiple layers and is resistant to microorganisms or STDs.

The increased surface area of this fragile layer (known as the cervical endothelium) becomes an ideal site for HIV and STD infection. This is because the cervical endothelium is the site of the chemokine receptors CCR-5 and CXCR-4, which must be present in order for HIV infection to occur. In fact, the cervix is considered to be the main site of HIV infection in women.

Progesterone Hormones
Progesterone hormones used in birth control pills can have several effects on the body that may increase the risk of HIV infection. The side effects of progesterone hormones may include the following:

• immune system suppression
• thinning of the endometrium
• endometrium atrophy
• irregular uterine bleeding

All of these factors may increase the risk of HIV transmission.

Other Considerations
Another common symptom of the birth control pill experienced by women is vaginal dryness. Vaginal dryness can lead to abrasions of the tissue surface, which can create an ideal site of HIV infection.

Lastly, it is important for all women who may be at risk of HIV infection or are using hormonal contraceptives to use barrier methods such as condoms that offer protection from STDs such as HIV/AIDS.

HIV and Microbicides

HIV and STD Prevention: The Cervical Cap and Microbicides

The search for HIV prevention has led to an exploration of a variety of methods developed to offer protection from sexually transmitted diseases. One of the most feasible options to date is the microbicide for the prevention of STDs - particularly HIV AIDS. While this method of STD prevention has failed in the past, recent developments have improved this device. The cervical cap known as the FemCap, in combination with a microbicide gel, could offer a viable option for HIV AIDS prevention in women.

What is a Microbicide?
A microbicide is a compound or substance that is used for the purpose of preventing infection of bacteria or viruses such as the HIV virus. Topical microbicides such as gels could be applied to condoms or directly to genitals in order to prevent infection of sexually transmitted diseases (STDs).

In the early years of the HIV AIDS pandemic, microbicides such as Nonoxynol-9 and, more recently, Cellulose Sulphate were used in an attempt to prevent STDs. However, these methods failed and even increased the risk of HIV transmission. Nonoxynol-9 in particular failed because although it destroyed the cell wall of the HIV, it also irritated the surface of the cervix, vagina, and rectum. This irritation led to the formation of sores, which served as sites for HIV AIDS and other STD infections.

HIV Infection and The Cervix
One of the major failures of microbicides in the past is attributed to a failure to take basic anatomy and immunology into consideration. In other words, how HIV AIDS infects a woman's body.

The cervix is actually the main site of HIV invasion, and is thus the area that requires the greatest protection. The cervical canal is lined with a single layer of vascular epithelium, which is extremely fragile. The cervix also has a high concentration of chemokine receptors (CCR-5 and CXCR-4) and many lymphocytes are present in this region. These receptors - which are almost absent from the mucus membranes of the vagina ­- must be present in order for HIV infection to occur.

According to some research, any irritation caused by microbicides will mobilize immune cells to the cervix, making them a target for HIV invasion and replication. This is particularly dangerous for women with cervical ectopy, a condition in which a single layer of endo-cervical cells extends beyond the border of the cervical os (cervical opening).

The FemCap and Microbicides
The FemCap in combination with a new microbicide known as Acidform (Amphora) has emerged as one potential method of STD (Sexually Transmitted Diseases)/HIV prevention in light of recent research.

Amphora is classified as a vaginal defense enhancer, and some believe it to be the most promising microbicide presently available. This is because it claims to fulfill two basic criteria:

• does not irritate the cervix
• does not stimulate the immune system

Amphora aims to preserve vaginal acidity even in the presence of semen. It also claims to protect and insulate the mucus membrane from HIV invasion, and kill STD and HIV organisms on contact.

Applying Amphora requires the use of a cervical cap known as the FemCap, which has long been approved in the United States and Europe as one of many viable birth control methods.

How FemCap Works
Previous use of microbicides involved either an applicator or a diaphragm. Supporters of the FemCap method point out that both of these methods of contraception cause irritation of the cervix and stimulate the immune system, putting individuals at greater risk of HIV infection. In the case of the diaphragm, the cervix is actually steeped in a pool of microbicides, increasing the risk of irritation.

The FemCap covers and protects the cervix from both the effects of microbicides as well as STD and HIV contact by acting as a barrier. The design of the FemCap allows for the storage and delivery of microbicides to the vaginal side, allowing the cervix to remain protected while killing STD organisms as soon as they come into contact with the vagina. The microbicide is naturally expelled through the vagina.

This method offers a potentially new option for the prevention of STD and HIV AIDS. Speak to your health care provider for more information about the FemCap and microbicides for STD prevention.

HIV/AIDS and Hispanic Americans

AIDS and Hispanic-Americans

While in recent years there has been increased awareness of the global HIV/AIDS epidemic, much less focus has been placed on the demographic groups that are at increased risk for HIV/AIDS within the United States. Such groups include the Hispanic-American population, an ethnic community that accounts for only 14% of the American population but which accounts for 19% of the close to 1 million Americans diagnosed with HIV/AIDS since the onset of this epidemic over 25 years ago. This figure is due to the fact that, for a variety of reasons, Hispanic Americans are, like African Americans, at a greater risk for HIV/AIDS than non-African and non-Hispanic Americans.

But why are Hispanic Americans at a greater risk for HIV/AIDS? And why is this risk of aids increasing among Hispanic Americans?

Hispanic Americans and HIV/AIDS: Facts and Figures

AIDS statistics for Hispanic Americans have become increasingly daunting.

Accounting for 19% of all HIV/AIDS cases in the United States, Hispanic Americans are more likely to die because of HIV/AIDS than Caucasian Americans; from 2000 to 2004, the number of deaths among Hispanic Americans from AIDS-related causes rose by 7%, compared to the 19% decline of AIDS related fatalities among American Caucasians.

Rates of HIV/AIDS are four times higher among Hispanic Americans than their Caucasian counterparts.

Hispanic American women made up 21% of HIV/AIDS cases in 2004 while Caucasian women made up 16% of AIDS cases in that same year. The rate of adult and adolescent Hispanic females affected by AIDS is the second highest rate in the country, affecting 12.4 people per 100,000, second only to the AIDS rate among African Americans.

Additionally, 89% of all Hispanic American HIV/AIDS cases affect Puerto Rican Americans, in addition to Hispanic Americans living in the following states: California, Connecticut, Florida, Illinois, Massachusetts, New Jersey, New York, Pennsylvania and Texas.

Why Are Hispanic Americans More Susceptible to HIV/AIDS?

Alone, race, ethnicity and gender do not explain why certain groups of the population are more susceptible to contracting HIV/AIDS. The following barriers and circumstances are most likely responsible for the disproportionate presence of HIV/AIDS among Hispanic Americans:

• Socioeconomic factors: currently, 22% (9.1 million) of the Hispanic American population lives below the American poverty line. Also, 24% (or 1 in 4) Hispanic Americans don’t have health insurance, compared with 17% of Caucasian Americans and 20% of African Americans, limiting access to important medical treatment and diagnosis
• STDs (Sexually Transmitted Diseases): on average, Hispanic Americans have higher rates of STDs, including syphilis and chlamydia. This is due in large part to a low use of condoms among Hispanic Americans. Fifty-one percent of HIV/AIDS cases among Hispanic-American men contracted the disease through heterosexual sex, while heterosexual sex led to the contraction of HIV/AIDS for 65% of Hispanic American women
• Limited knowledge and lack of testing: According to a recent study, 48% of Hispanic Americans are unaware that they are infected with HIV, compared with 67% of African Americans and 18% of Caucasian Americans. Also, on average, Hispanic Americans are tested for HIV/AIDS later than their Caucasian counterparts: 39% (more than one-third) of Hispanic Americans are diagnosed with AIDS within a year of testing positive for HIV, suggesting an extremely tardy diagnosis, which also likely accounts for the group’s high fatality rate
• * Cultural and linguistic barriers: such barriers can contribute to a fear of the disease, as well as stereotypes, thereby hindering information on practicing safe sex in order to avoid sexually transmitted diseases. Also, such barriers can hinder communication with care givers

What is Being Done to Combat this Epidemic?

A variety of initiatives have been developed to combat the growing HIV/AIDS epidemic in the Hispanic American community.

For example, the Centers for Disease Control and Prevention and the Academy for Educational Development have established the VOICES/VOCES (Video Opportunities for Innovative Condom Education and Safer Sex) initiative. This initiative promotes condom use for Hispanic Americans, and also plays an active role in their distribution among the Hispanic American community.

In addition, the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act runs programs on HIV/AIDS education and support for women, youth and family affected with HIV/AIDS in areas of the country most affected by the disease.

The CARE Act also has programs in place in order to improve standards of health care for refugees living along the Mexican-American border.