Depo-Provera and HIV transmission:
WHO to trust?

The following article about Depoprovera and HIV transmission guidelines was published in DifferenTakes. It is a publication of the Population and Development Program PopDev (

Editor’s note

Concerns about Depo-Provera and increased rates of HIV transmission are of vital importance to women’s health, especially to those at high risk of HIV acquisition. Despite compelling evidence of a Depo-Provera-HIV link and regulatory bodies’ unclear guidance around the method’s use,1 distribution of the injectable contraceptive has been on the rise. For instance, in 2017 the Indian government began offering free Depo injections through its public health system, despite opposition from women and health groups in India.2 Since 2008, a public-private partnership has tested and distributed the Sayana Press, which delivers a lower dosage formulation of Depo-Provera, in countries including Uganda, Senegal, and Niger.3

In this DifferenTakes, scholar C. Sathyamala critically examines the ECHO trial, which aimed to conclusively answer the Depo-Provera-HIV question. It ended in spring 2019. The author argues that the trial results add to the existing evidence that Depo-Provera increases the risk of HIV transmission. She challenges the World Health Organization’s June 13 statement reporting “no link.” This stance, she argues, dangerously misrepresents the study’s findings and, further, disregards key critical challenges, including those from AIDS and reproductive justice activists. As the author argues, the World Health Organization guidance fails to appropriately warn users of the potential risk associated with Depo-Provera use and wrongly concludes that it is “safe.”
— Anne Hendrixson

World Health Organization (WHO) guidelines recommend: “Women at a high risk of HIV infection are eligible to use all progestogen-only contraceptive methods without restriction(MEC Category 1), including progestogen-only pills (POPs), intramuscular and subcutaneous depot medroxyprogesterone acetate (DMPA-IM and DMPA-SC), norethisterone enanthate (NET-EN), levonorgestrel (LNG)
implants and etonogestrel (ETG) implants.”

Read Article HERE


  1. See for instance Marion Stevens, “Elevated Risk: Injectable Contraceptives and HIV—a Reproductive Justice
    Perspective from the Global South,” DifferenTakes, no. 90, Summer 2017,
  2. Shaifali Agrawal, “Risking Health Of Its Women, India Uses Controversial Contraceptive In Family
    Planning Programme,” IndiaSpend, October 18, 2017,
  3. See Daniel Bendix, Ellen E. Foley, Anne Hendrixson and Susanne Schultz, “Targets and Technologies: Sayana Press and Jadelle in
    Contemporary Population Policies,” Gender, Place & Culture,
  4. Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium, “HIV Incidence Among Women Using
    Intramuscular Depotmedroxyprogesterone Acetate, a Copper Intrauterine Device or a Levonorgestrel Implant for Contraception:
    A Randomised, Multicentre, Open-label Trial,” The Lancet, (June 13, 2019)
  5. See for instance, World Health Organization, “Hormonal Contraceptive and HIV: Science and Policy,” Geneva: World Health
    Organization, 2005, (
  6. Renee Heffron, Deborah Donnell, Helen Rees, et al., “Use of Hormonal Contraceptives and Risk of HIV-1 Transmission: A
    Prospective Cohort Study” Lancet Infectious Diseases, vol. 12, (February 2012): 19–26.
  7. Paula Donovan, “The UN’s Gag Order on Reproductive Health,” AIDS-Free World, February 13, 2012,
  8. World Health Organization, “Hormonal Contraception and HIV: Technical Statement. WHO/RHR/12.08.” Geneva: WHO, 2012,
  9. G. Justus Hofmeyr, Charles S. Morrison, Jared Baeten, et al., “Rationale and Design of a Multi-center, Open-label, Randomised
    Clinical Trial Comparing HIV Incidence and Contraceptive Benefits in Women Using Three Commonly-used Contraceptive
    Methods (the ECHO study), [version2; referees 2 approved],” Gates Open Research (2018), 1, 17.
  10. Gianni Di Perri, “How Does Contraceptive Use Increase the Risk of HIV Acquisition?” 15th European AIDS conference, October 21-
    24, 2015,
  11. Lauren J. Ralph, Sandra I. McCoy, Timothy Hallet and Nancy Padian, “Next Steps for Research on Hormonal Contraception and
    HIV,” The Lancet, vol. 382, no.9903 (June 28, 2013): 1467–1469.
  12. World Health Organization. “Hormonal Contraceptive Methods for Women at High Risk of HIV and Living with HIV, 2014 Guidance
    statement,” (2014),
  13. Lillian Mworeko and Mitchell Warren, “Women’s Response to new WHO statement on DMPA,” Letter to Dr. Margaret Chan,
    Director General of the World Health Organization and Dr. James Kiarie, Coordinator, Human Reproduction Team, World Health
    Organization. Undated.
  14. Ibid

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