{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:05:23Z","timestamp":1768320323358,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T00:00:00Z","timestamp":1573776000000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000278","name":"Department for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000278","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Some studies suggest that use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase susceptibility to HIV infection. We aim to determine the influence that such an association could have had on the HIV epidemic in South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We simulate the heterosexual adult HIV epidemic in South Africa using a compartmental model stratified by age, behavioural risk group, sex, male circumcision status and contraceptive use. We model two possible scenarios: (1) The \u201cWith Effect\u201d scenario assumes that DMPA increases susceptibility to HIV infection by 1.20\u2010fold (95% confidence interval 1.06 to 1.36) based on a combination of the results of a recent randomised controlled trial (ECHO trial) and a number of observational studies. (2) The \u201cNo Effect\u201d scenario assumes that DMPA has no effect on HIV acquisition risk. We calculate the difference in HIV\u2010related outcomes between the With Effect and No Effect scenarios to determine the potential impact that DMPA use could have had on the HIV epidemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A causal association between DMPA and HIV acquisition could have caused 430,000 (90% of model runs 160,000 to 960,000) excess HIV infections and 230,000 (90,000 to 470,000) AIDS deaths in South Africa from 1980 to 2017. These figures represent 4.3% (1.6% to 9.6%) and 6.9% (2.6% to 15.2%) of the total modelled estimates of HIV infections and AIDS deaths respectively in South Africa in that period. Of the additional infections, 36% (25% to 48%) would have occurred among men. If DMPA use continues at current levels, a potential causal association could cause an additional 130,000 (50,000 to 270,000) infections between 2018 and 2037. The excess infections would have required an additional 640,000 (190,000 to 1,660,000) years of ART from 1980 to 2017, and a further 2,870,000 (890,000 to 7,270,000) years of ART from 2018 to 2037.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>If there is a causal association between DMPA use and HIV risk, it could have substantially increased the scale of the HIV epidemic in South Africa, affecting not only the users of DMPA, but also their partners and the wider population. The magnitude of this potential effect demands careful data collection and a careful consideration of policy choices for contraception in settings with large HIV epidemics.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25414","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T08:18:02Z","timestamp":1573805882000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["What impact could DMPA use have had in South Africa and how might its continued use affect the future of the HIV epidemic?"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0792-4914","authenticated-orcid":false,"given":"Leo","family":"Beacroft","sequence":"first","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis Department of Infectious Disease Epidemiology Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A","family":"Smith","sequence":"additional","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis Department of Infectious Disease Epidemiology Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy B","family":"Hallett","sequence":"additional","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis Department of Infectious Disease Epidemiology Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,15]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"United Nations Department of Economic and Social Affairs PD.Trends in contraceptive use. Worldwide 2015. Contraception.2015.1\u201370p."},{"key":"e_1_2_10_3_1","unstructured":"National Department of Health (NDoH) Statistics South Africa (Stats SA) SAMR Council (SAMRC) and I.South Africa Demographic and Health Survey 2016: Key Indicators. Pretoria South Africa and Rockville Maryland USA: NDoH Stats SA SAMRC and ICF;2017."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001228"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2017-00103"},{"key":"e_1_2_10_6_1","volume-title":"Hormonal contraceptive methods for women at high risk of HIV and living with HIV","author":"World Health Organization","year":"2017"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31288-7"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.01.005"},{"key":"e_1_2_10_9_1","unstructured":"United Nations Department of Economic and Social Affairs PD.UN World Contraceptive Use 2018.2018."},{"key":"e_1_2_10_10_1","unstructured":"UNAIDS.UNAIDS AIDSinfo[Internet].2019[cited 2019 Jan 21]. Available from:http:\/\/aidsinfo.unaids.org\/"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835ca2dd"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30036-4"},{"key":"e_1_2_10_13_1","unstructured":"Actuarial Society of South Africa.ASSA 2008 Model.2011."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.12688\/gatesopenres.12775.1"},{"key":"e_1_2_10_15_1","volume-title":"Zambia Demographic and Health Survey 2013\u201314","author":"Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International","year":"2014"},{"key":"e_1_2_10_16_1","unstructured":"World Health Organization.Hormonal contraceptive methods for women at high risk of HIV and living with HIV. 2014 guidance statement.Geneva Switzerland;2014."},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"issue":"5","key":"e_1_2_10_18_1","first-page":"1","article-title":"Trends in maternal mortality\u202f: 1990 to 2015","volume":"32","author":"World Health Organisation","year":"2015","journal-title":"World Heal Organ"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25414","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25414","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25414","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T14:20:04Z","timestamp":1694182804000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":17,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1002\/jia2.25414"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25414","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]},"assertion":[{"value":"2019-03-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25414"}}