Abstract

PIP: Epidemiologic and laboratory evidence exists that condom use can prevent the transmission of HIV. Indeed condoms are the only recommended contraceptive for prevention of HIV transmission. Most epidemiologic studies demonstrate that condom use protects women from acquiring HIV, but few examine the effectiveness of condoms in preventing heterosexual transmission to men. Condom use is not always an acceptable contraceptive method, however. Laboratory tests show that the spermicides nonoxynol-9, octoxynol, benzalkonium chloride, and menfegol deactivate HIV and kill other organisms that cause sexually transmitted diseases. In the field, however, spermicides are not reliable in protection against HIV transmission. For example, a study in Kenya of 98 prostitutes reveals that 55% of the nonoxynol-9 users seroconverted whereas 45% of the placebo users did. Another study in Kenya involving prostitutes demonstrates that oral contraceptive (OC) users had a 3 fold increased risk of acquiring HIV. Yet a different study in Kenya finds that HIV infected women were not more likely to be using OCs than noninfected women. There was an association with 6 years of OC use and HIV infection, however. In addition, a study in Milan, Italy provides evidence of a possible protective effect of OC use. It shows that HIV negative women tend to use OCs more often than did HIV positive women. Nevertheless both the last mentioned study in Kenya and the Italian study shows an increased HIV infection rate with IUD users. Furthermore, HIV infection does not appear to affect fertility. For example, 1 study shows pregnancy rates of 11.6/100 person years for HIV infected women and 10.3 for noninfected women.