Hormonal contraception and risk of cervical infections among HIV-1-seropositive Kenyan women

AIDS. 2004 Nov 5;18(16):2179-84. doi: 10.1097/00002030-200411050-00010.


Objective: To evaluate the relationship between hormonal contraceptive use and the acquisition of cervical sexually transmitted infections (STI) among HIV-1-infected women.

Design: A prospective cohort study of 242 commercial sex workers in Mombasa, Kenya, followed from the time of HIV-1 infection.

Methods: At monthly follow-up visits, sexual behavior and contraceptive use were recorded, and laboratory screening for STI was performed. Multivariate Andersen-Gill proportional hazards models were constructed to examine the association between the use of hormonal contraception and the occurrence of cervical STI.

Results: The median duration of follow-up after HIV-1 acquisition was 35 months, and 799 person-years of follow-up were accrued. After adjustment for demographic factors and sexual behavior, women using the injectable contraceptive depot medroxyprogesterone acetate were at increased risk of Chlamydia trachomatis infection [hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.0-9.4, P = 0.05] and cervicitis (HR 1.6, 95% CI 1.0-2.3, P = 0.03) compared with women using no contraception. The use of oral contraceptive pills was associated with an increased risk of cervicitis (HR 2.3, 95% CI 1.4-3.8, P = 0.001). Hormonal contraception was not associated with an increased risk of infection with Neisseria gonorrhoeae.

Conclusion: The use of hormonal contraception by HIV-1-infected women was associated with an increased risk of cervicitis and cervical chlamydia infection. HIV-1-seropositive women using hormonal contraception should be counseled about the importance of consistent condom use to prevent both STI and HIV-1 transmission.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chlamydia Infections / transmission
  • Contraceptives, Oral, Hormonal / administration & dosage*
  • Developing Countries*
  • Female
  • Follow-Up Studies
  • HIV Seropositivity*
  • HIV-1*
  • Humans
  • Injections, Intravenous
  • Kenya
  • Medroxyprogesterone Acetate / administration & dosage*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk
  • Sex Work
  • Sexually Transmitted Diseases / transmission
  • Uterine Cervicitis / etiology*


  • Contraceptives, Oral, Hormonal
  • Medroxyprogesterone Acetate