The results of a large clinical research study ‒ known as the Evidence for Contraceptive Options and HIV Outcomes (ECHO) ‒ sought to resolve long-standing questions on a potential link between hormonal contraceptive use and the risk of HIV acquisition. Although the results found no significant difference in HIV risk among women using one of three highly effective contraceptive methods in the trial, it is not all good news. The findings showed high rates of HIV acquisition.
The participants in the study were all sexually active women with more than 80% being under the age of 25 years. Participants were offered a range of HIV prevention options alongside the contraceptive offered to them in the study. HIV prevention approaches included risk reduction counselling, HIV and STI testing and counselling, condoms and pre-exposure prophylaxis (PrEP) as and when it became available in the national guidelines of each country. Yet the rate of HIV acquisition in the trial was 3.8%, representing 387 women who acquired HIV in the study period. For these women, integration of services failed to meet their needs.
The results from the ECHO study must serve as a wake-up call to the global community. For years, we have been speaking about integrating sexual and reproductive health and rights and HIV services. Yet the results of this trial prove that the rhetoric lags far behind the reality and the commitments made. The findings are clear: HIV prevention must be better integrated within the provision of effective and safe contraceptive methods and vice versa.
These results provide policymakers, health programmers and public health officials the evidence they need to:
- Provide access to a range of contraceptive methods, particularly women-controlled long acting contraceptive options for young women and adolescent girls
- Prioritize participation of women and girls in decision-making processes to demand integrated contraceptive choice and comprehensive HIV prevention services that better meet their individual needs
- Support the training of healthcare providers to deliver a range of effective and safe contraceptive options and comprehensive HIV prevention services, including PrEP.
The legacy of the ECHO trial should go beyond sustaining expanded contraceptive choices available to women in and around the study sites. The results from the ECHO trial reinforce the importance of not only doing more – but doing more effectively - to meet the HIV prevention and contraceptive needs of young women and adolescent girls.