Hormonal contraception, sexually transmitted diseases, and risk of heterosexual transmission of human immunodeficiency virus type 1

J Infect Dis. 1998 Oct;178(4):1053-9. doi: 10.1086/515654.


To examine associations between method of contraception, sexually transmitted diseases (STDs), and incident human immunodeficiency virus type 1 (HIV-1) infection, a prospective observational cohort study was done among female sex workers attending a municipal STD clinic in Mombasa, Kenya. Demographic and behavioral factors significantly associated with HIV-1 infection included type of workplace, condom use, and parity. In multivariate models, vulvitis, genital ulcer disease, vaginal discharge, and Candida vaginitis were significantly associated with HIV-1 seroconversion. Women who used depo medroxyprogesterone acetate (DMPA) had an increased incidence of HIV-1 infection (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.4-3.4). In a multivariate model controlling for demographic and exposure variables and biologic covariates, the adjusted HR for HIV-1 infection among DMPA users was 2.0 (CI, 1.3-3.1). There was a trend for an association between use of high-dose oral contraceptive pills and HIV-1 acquisition (HR, 2.6; CI, 0.8-8.5).

Publication types

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

MeSH terms

  • Behavior
  • Candidiasis, Vulvovaginal
  • Contraception*
  • Contraceptive Agents, Female
  • Contraceptive Devices
  • Demography
  • Female
  • HIV Seropositivity / complications
  • HIV Seropositivity / epidemiology*
  • HIV-1*
  • Humans
  • Kenya
  • Medroxyprogesterone Acetate / adverse effects
  • Multivariate Analysis
  • Prospective Studies
  • Risk Factors
  • Sex Work*
  • Sexually Transmitted Diseases / complications
  • Sexually Transmitted Diseases / epidemiology*
  • Ulcer
  • Vaginal Discharge
  • Vulvitis


  • Contraceptive Agents, Female
  • Medroxyprogesterone Acetate