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Population-level impact of hormonal contraception on incidence of HIV infection and pregnancy in women in Durban, South Africa/Impact au niveau de la population de la contraception hormonale sur l'incidence de l'infection par le VIH et sur la grossesse chez des femmes de Durban, en Afrique du Sud/El impacto en el nivel de poblacion de la anticoncepcion hormonal en la incidencia de la infeccion por el VIH y en el embarazo de mujeres de Durban, Sudafrica. Objective To estimate the potential impact of using hormonal contraceptives on tares of infection with human immunodeficiency virus type 1 (HIV-1) and pregnancy by theoretically removing the use of hormonal contraceptives from a study population. Methods A prospective cohort study included 3704 HIV-negative women who were enrolled in two biomedical trials that tested two vaginal microbicides (PRO 2000 and Carraguard[R]) for the prevention of HIV-1 in Durban, South Africa, in 2004-2009. Cox proportional hazards regression models along with partial population attributable risks (PARs) and their 95% confidence intervals (CIs) were calculated to assess the relative population-level impact of the use of hormonal contraceptives on HIV-1 seroconversion rates and on pregnancy rates. Findings Women who reported using hormonal contraceptives at enrolment in the trial had a higher risk of HIV-1 seroconversion (adjusted hazards ratio: 1.24; 95% CI: 0.97-1.58) than women who reported using other types of contraceptives at enrolment. At the population level, the use of hormonal contraceptives (pills or injectables) at baseline and during study follow-up accounted for approximately 20% (95% CI: 16-22) of HIV-1 seroconversions. However, the partial PAR indicated a relative impact of 12% (95% CI: 9.0-15.7). On the other hand, 72% (95% CI: 66-77) of the pregnancies could have been avoided if all women had used hormonal contraceptives. Conclusion Women using hormonal contraceptives need comprehensive counselling on simultaneous prevention of HIV-1 infection. Objectif Estimer l'impact potentiel de l'utilisation de contraceptifs hormonaux sur les taux d'infection par le virus d'immunodeficience humaine de type 1 (VIH-1) et sur la grossesse par suppression theorique de l'utilisation de contraceptifs hormonaux dans une population temoin. Methodes Une etude de cohorte prospective comprenait 3704 retomes seronegatives qui etaient inscrites dans deux etudes biomedicales testant deux microbicides vaginaux (PRO 2000 et Carraguard[R]) pour la prevention du VIH-1 a Durban, en Afrique du Sud, de 2004 a 2009. Les modeles de regression a risque proportionnel de Cox ainsi que les risques attribuables dans la population (RAP) partielle et leurs intervalles de confiance (IC) de 95% ont ete calcules pour evaluer l'impact relatif au niveau de la population de l'utilisation de contraceptifs hormonaux sur les taux de seroconversion du VlH-1 et sur les taux de grossesse. Resultats Les femmes qui ont declare utiliser des contraceptifs hormonaux lors de l'inscription a l'essai clinique presentaient un risque accru de seroconversion du VIH-1 (taux de risque ajuste: 1,24; IC de 95%: 0,97 a 1,58) par rapport aux femmes qui ont declare utiliser d'autres types de contraceptifs lors de l'inscription. Au niveau de la population, l'utilisation de contraceptifs hormonaux (comprimes ou injectables) au debut et au cours du suivi de l'etude a represente environ 20% (IC de 95%: 16 a 22%) des seroconversions du VIH-1 .Toutefois, le RAP partiel a indique un impact relatifde 12% (IC de 95%: 9 a 15,7%). D'autre part, 72% (IC de 95%: 66 a 77%) des grossesses auraient pu etre evitees si toutes les femmes avaient utilise des contraceptifs hormonaux. Conclusion Les retomes qui utilisent des contraceptifs hormonaux necessitent des conseils detailles sur la prevention simultanee de l'infection par le VIH-1. [TEXT NOT REPRODUCIBLE IN ASCII.] Objetivo Calcular el posible impacto del uso de anticonceptivos hormonales sobre las rasas de infeccion por el virus de la inmunodeficiencia humana del tipo 1 (VIH-1) y sobre el embarazo bajo el supuesto de eliminar el uso de anticonceptivos hormonales de la poblacion estudiada. Metodos Entre los anos 2004 y 2009, un estudio de cohortes prospectivo incluyo a 3704 mujeres VIH negativas inscritas en dos ensayos biomedicos que evaluaron dos microbicidas vaginales (PRO 2000 y Carraguard[R]) para la prevencion del VIH-1 en Durban, Sudafrica. Se calcularon los modelos de regresion de Cox junto con los riesgos parciales atribuibles a la poblacion y sus intervalos de confianza (IC) del 95% para evaluar el impacto relativo del uso de anticonceptivos hormonales sobre las rasas de seroconversion del VIH-1 y las de embarazo entre la poblacion. Resultados El riesgo de seroconversion del VIH-1 fue superior en las mujeres que declararon utilizar anticonceptivos hormonales en el momento de la inscripcion en el ensayo (indice de riesgos ajustado: 1,24; IC del 95%: 0,97-1,58) que en las mujeres que declararon utilizar otros tipos de anticonceptivos. Entre la poblacion, el uso de anticonceptivos hormonales (pildoras o inyectables) en el punto de partida y durante el seguimiento del estudio represento aproximadamente el 20% (IC del 95%: 16-22) de las seroconversiones del VlH-1. No obstante, el riesgo parcial atribuible a la poblacion indico un impacto relativo del 12% (IC del 95%: 9.0-15.7). Por otra parte, el 72% (IC del 95%: 66-77) de los embarazos podria haberse evitado si todas las mujeres hubieran tomado anticonceptivos hormonales. Conclusion Las mujeres que usan anticonceptivos hormonales necesitan un asesoramiento amplio sobre la prevencion de la infeccion por el VIH., Introduction In sub-Saharan Africa, an estimated 22.5 million people live with human immunodeficiency virus type 1 (HIV-1) infection. (1) In the province of KwaZulu-Natal, the prevalence of HIV-1 infection is [...]

Background: In South Africa, the severity of the HIV/AIDS epidemic varies according to geographical location; hence, localized monitoring of the epidemic would enable more effective prevention strategies. Our objectives were to assess the core areas of HIV infection in KwaZulu‐Natal, South Africa, using epidemiological data among sexually active women from localized communities. Methods: A total of 5753 women from urban, peri‐rural and rural communities in KwaZulu‐Natal were screened from 2002 to 2005. Each participant was geocoded using a global information system, based on residence at time of screening. The Spatial Scan Statistics programme was used to identify areas with disproportionate excesses in HIV prevalence and incidence. Results: This study identified three hotspots with excessively high HIV prevalence rates of 56%, 51% and 39%. A total of 458 sexually active women (19% of all cases) were included in these hotspots, and had been exclusively recruited by the Botha's Hill (west of Durban) and Umkomaas (south of Durban) clinic sites. Most of these women were Christian and Zulu‐speaking. They were also less likely to be married than women outside these areas (12% vs. 16%, p = 0.001) and more likely to have sex more than three times a week (27% vs. 20%, p < 0.001) and to have had more than three sexual partners (55% vs. 45%, p < 0.001). Diagnosis of genital herpes simplex virus type 2 was also more common in the hotspots. This study also identified areas of high HIV incidence, which were broadly consistent with those with high prevalence rates. Conclusions: Geographic excesses of HIV infections at rates among the highest in the world were detected in certain rural communities of Durban, South Africa. The results reinforce the inference that risk of HIV infection is associated with definable geographical areas. Localized monitoring of the epidemic is therefore essential for more effective prevention strategies ‐ and particularly urgent in a region such as KwaZulu‐Natal, where the epidemic is particularly rampant., Background It is estimated that more than 60% of the world's HIV‐infected population lives in sub‐Saharan Africa, and South Africa is currently experiencing the heaviest HIV/AIDS load in the world [...]

The study attempts to evaluate the efficacy of cellulose sulfate gel in the prevention of vaginal HIV transmission among women. The results indicate that cellulose sulfate gel did not prevent HIV transmission and may have even increased the risk of getting HIV.

In sub-Saharan Africa, almost 60% of HIV infections are among women [1], and the number of new HIV infections in women worldwide continues to escalate. The high incidence of HIV [...]

Objectives. We examined perceptions of the effectiveness and acceptability of a candidate microbicide among 94 South African female sex workers who had participated in a phase 3 microbicide trial for HIV prevention. Methods. Sixteen focus groups were conducted in 2001, 12 to 15 months after participants were informed that the candidate microbicide had been determined to be ineffective in preventing HIV and other sexually transmitted infections (STIs). Results. Participants clearly indicated that they understood the experimental nature of the candidate microbicide, and they recognized that they had been informed after the trial that the product was ineffective. Nevertheless, most continued to believe that the candidate microbicide helped prevent HIV and other STIs, alleviated reproductive tract pain and STI symptoms, and helped to clean the vagina. Conclusions. These findings underscore the importance of understanding women's perceptions of the efficacy of candidate microbicides and the rationale for these beliefs. These issues need to be addressed in counseling throughout microbicide trials for HIV prevention. These results also demonstrate how desperate many women at high risk of HIV infection may be for new HIV prevention technologies. doi:10.2105/AJPH.2004.047514)

The impact of prevalent and incident HSV-2 infection on the incidence of HIV-1 infection in a cohort of female commercial sex workers in KwaZulu-Natal, South Africa is investigated. The incident HSV-2 infection increases the risk of HIV-1 infection, the effect wanes with time since infection and the effect is significantly greater for men than it is for women.

With growing recognition of the potential value of microbicides for HIV/STI prevention, the importance of the acceptability of this brand-new technology has been widely acknowledged. We review the current body of microbicide acceptability research, characterize the limitations in assessment approaches, and suggest strategies for improvement. Electronic databases and abstracts of recent meetings were searched for acceptability data regarding vaginal and rectal products that may be used for HIV prevention. Of the 61 studies reviewed, more than half assessed acceptability based primarily on the description of a hypothetical microbicide, or with the demonstration of a spermicide or lubricant. Physical characteristics of microbicidal products, their effects after insertion, and their effects on sensation during intercourse (for both partners) were the dimensions most frequently assessed (measured in 77%, 49% and 49% of studies, respectively). Attention to the social context of use was inadequate. As acceptability is likely to be a key determinant in the use-effectiveness of microbicides, in-depth understanding of the social processes that shape microbicide acceptability across diverse populations will become increasingly valuable. This includes exploring the effects that sexual partners, health care providers, and key opinion leaders have on the acceptability of microbicides among women and men, including youth and people living with HIV. Future research will benefit from studies of the acceptability of other contraceptive-barrier methods (especially the female condom), use of an agreed-upon operationalization of acceptability, use of acceptability assessments within clinical trials, expansion of measurement domains, and assessment of changes in perceptions of acceptability and use over time. Failure to understand the key factors associated with microbicide acceptability is likely to hinder the adoption and continued use of products that are effective in preventing HIV infection. Keywords: Microbicides; HIV/AIDS prevention; Sexually transmitted infections; Vaginal products; Spermicides; Female condom