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As the UK faces extraordinary political uncertainty, much of the world faces austerity, and sexual health services are squeezed in many places, much of the new evidence in this journal issue relates to resources, and relationships. Wherever cost is a high priority in sexual health, it is unsurprising to find a focus on long-acting reversible contraception (LARC) – a group of methods with high cost-effectiveness, but also questions over acceptability and suitability in certain groups. One trial in HIV-infected individuals in this issue addresses the vexed question of whether LARC may increase HIV transmission, while other studies reassure us that missing intrauterine device (IUD) strings following postpartum insertion may reappear in due course, and confirm clear health benefits for disadvantaged women from free intrauterine system (IUS) access. Finally, both a subjective account and objective evidence remind us, if we needed it, of the power of strong, effective clinical relationships in delivering healthcare which is both acceptable and effective.
Early evidence suggests trials of the effects of hormonal contraception on HIV acquisition are possible
The possibility that hormonal contraception, particularly injectable depot medroxyprogesterone acetate (DMPA), increases the risk of HIV acquisition has been discussed for more than 30 years. Hofmeyr and colleagues set out to investigate this possibility in their open-label randomised controlled trial of the IUD vs injectable progestogen contraception (IPC) in two South African hospitals. The primary outcome was pregnancy. Secondary outcomes included HIV acquisition, and the authors present these data here. According to intention-to-treat analysis, HIV acquisition occurred in 20/656 (3.0%) women in the IPC arm and 22/634 (3.5%) women in the IUD arm (IPC vs IUD, risk ratio 0.88; 95% CI 0.48 –1.59; p=0.7). The study was thus underpowered to demonstrate any difference in acquisition, but it does demonstrate the feasibility of conducting such a trial to definitively answer this important question. See page 175
Providing free LNG-IUS to low-income women promotes women's health
What are the overall benefits of the …
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