Contraception method and risk of HIV acquisition

In a large open-label trial in 12 research sites in sub-Saharan
Africa, HIV-negative women aged 16-35 were randomized to
one of three different contraception methods. The HIV-incidence
was compared between those who received intramuscular
depot medroxyprogesterone acetate (DMPA-IM), a copper
intrauterine device (IUD), or levonorgestrel implant (LNG).
7,829 women were randomized 1:1:1 to the three different arms and followed for 18 months.
A total of 397 HIV-infections occurred — 3.81 per 100 years of follow up.
The incidence was 4.19 per 100 years of follow up in DMPA-IM
arm, 3.94 in the IUD arm, and 3.31 in the LNG arm.
The differences between the arms were not statistically significant.

Ref; Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial
Consortium. Lancet 2019;394:303-313

Comment: Earlier observations have suggested that the use of
DMPA-IM is associated with increased risk of HIV acquisition
compared to other methods of contraception. In this very large
randomized study the overall incidence of HIV-infection was
high but no statistically significant differences between the
three different contraception methods were found and the
authors conclude that all three contraception methods are recommended.