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Depo use increased in Africa despite evidence of HIV risk

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In the 12 African countries with the worst HIV epidemics — with 5.2% to 27.2% of adults aged 15-49 years living with HIV infections in 2016 — the percentage of married or in-union women using injectable contraceptives (primarily Depo ranged from 2.1% in Equatorial Guinea to 30% in Malawi, with a median of 19.3% (see Table below).

In these 12 countries, the percentage of women using injectable birth control increased from the mid-1990s — when scientists first recognized evidence Depo use likely increased women’s risk to get HIV — to the latest information on birth control use. In these 12 countries with the worst HIV epidemics, the median percentage of partnered women using injectable birth control  more than doubled from 8.1% in surveys on or around 1996 to 19.3% in the latest surveys (see Table below).

Depo use is much more common in Africa than in most countries around the world. For example, 0% of partnered women aged 15-49 years in China use injectable birth control, 0.1% in India, and 1.3% in the US.

Table: Percent of married or in-union women aged 15-49 years using injections* for birth control

Region, country 2016 adult HIV prevalence (%) % using injections*
Survey year 1996 or earliest year after 1996 Year of last reported survey
Year of survey % using injectables Year of survey % using injectables
Africa: 12 countries with >5% adult HIV-prevalence in 2016
Swaziland 27.2% 2000 11.6% 2014 21.9%
Lesotho 25.0% 2000 13.9% 2014 24.0%
Botswana 21.9% 2000 8.1% 2007-8 6.8%^
South Africa 18.9% 1998 23.2% 2003-4 28.4%
Namibia 13.8% 2000 18.7% 2013 26.8%
Zimbabwe 13.5% 1999 8.1% 2015 9.6%
Zambia 12.5% 1996-97 1.0% 2013-14 19.3%
Mozambique 12.3% 1997 2.3% 2011 5.1%
Malawi 9.2% 1996 6.4% 2015-16 30%
Uganda 6.5% 2000-1 6.4% 2016 18.1%
Equatorial Guinea 6.2% 2000 2.3% 2011 2.1%
Kenya 5.2% 1996 11.8% 2015 19.2%
Median for 12 Africa countries with the highest HIV prevalence 8.1% 19.3%
Selected other countries
China 0.04% 2006 0%
India 0.3% 2005-6 0.1%
United States 0.4% 2011-13 1.3%

* Primarily Depo-provera (DMPA) but may also include some women using NET-EN (norethisterone enanthate) and CICs (injections with estrogens and progestins).

^ % of all women.

Sources for HIV prevalence: Percentage of adults aged 15-49 years with HIV for all countries except China and the US: UNAIDS. HIV estimates with uncertainty bounds 1990-2016. Geneva: UNAIDS, 2017. Available at: http://www.unaids.org/en/resources/documents/2017/HIV_estimates_with_uncertainty_bounds_1990-2016 (accessed 12 October 2017). HIV prevalence for China is for the entire population at end-2014 from: National Health and Family Planning Commission of the People’s Republic of China. 2015 China AIDS Response Progress Report. 2015. Available at: http://www.unaids.org/sites/default/files/country/documents/CHN_narrative_report_2015.pdf (accessed 20 February 2018). HIV prevalence for the US is for adolescents and adults aged 13 and older end-2015 from: Centers fo Disease Control and Prevention. HIV Surveillance Report, 2016. Vol 28. 2017.  Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf (accessed 20 December 2018).

Source for injectable contraceptive use: Percentage of women using injectable contraception: data for all countries except China and the US: United Nations, Department of Economic and Social Affairs, Population Division (2017).  World Contraceptive Use 2017 (POP/DB/CP/Rev2017). Available at: http://www.un.org/en/development/desa/population/publications/dataset/contraception/wcu2017.shtml (accessed 20 February 2018).

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