Africa: After ECHO, Let's Find Out Why Women Are Not Using Barrier Methods

A panel presents the findings of the Echo study - the product of a three-year study conducted among about 7 800 women in eSwatini, South Africa, Kenya and Zambia. Using these contraceptives will not increase women's chances of acquiring HIV, the Evidence for Contraceptive Options and HIV Outcome scientists have revealed.
18 June 2019

Durban — So, the Evidence for Contraceptive Options and HIV Outcome (ECHO) study has found no significant difference in risk of HIV acquisition among women using one of three most methods of birth of control that are used on the continent - Depo-Medroxyprogesterone Acetate (DMPA, Depo-Provera), the Copper IUD and Jadelle implant. The results of the study were announced at the 9th SA Aids Conference in Durban by a panel of doctors, scientists and activists.

allAfrica's Sethi Ncube spoke to Jacqueline Wambui, an advocate for women's rights and member of the Global Community Advisory Group for ECHO.

1. Are you happy with the results? Are they what you were hoping to hear?

In terms of the link with HIV acquisition, the results are OK. At least it shows that there's no 50% increase in the acquisition of HIV using any of the methods. What is upsetting is the high rate of HIV incidence and STIs for the women within the trial, over 300 women were infected with HIV so that is a big concern for us. It shows that we are not doing very well in terms of prevention and it shows that prevention methods may be available but they are not being used, so we need to find out why women are not using prevention methods. Is it a social factor, is it scientific, is it the methods don't work? So that is the concern for us.

2. What do you think governments/health department across the continent should do from now going forwards?

What we are emphasising is the issue of method mix, the study shows that method mix is possible. It's possible for a woman to go to a facility and be given information on all the available methods of contraception not to focus on one contraceptive which we all know has been happening for a lot of African women is the use of a lot of DMPA, so it shows that it's possible. We are insisting that method mix should continue, it should be made more available and the woman should have access to this information.

3. What would you like us as the media to do to help make the work you do easier?

Help us give the information to the woman, so that she understands all these things. You see a woman has one body, especially a young woman, she has to prevent herself from getting HIV infection, she has to prevent herself from falling pregnant early so this information is there but sometimes it's not accessible to the women who live especially in the rural areas. Especially for those who are close-knit and may have to have unprotected sex to get many favours to just get a simple meal and this happens to women who are not empowered. So us as communities it's a bit tough for us to try and get this information out there because we don't have the funding and resources but the media is widely used. And there are different ways that people can access media so that would be a good way to help us on that, just information dissemination.

4. What do you wish to ECHO researchers focus on now, now that this chapter is closed?

Just to give us methods that are accessible and easy to use because there are something prevention methods that are so difficult to use like the female condom. Everybody talks about the condom but the condom is for the man. And you can't force a man to use a condom, so a woman doesn't have control over whether she can use the condom or not.

The female condom is made in a way that it is just difficult to use, most women call it a "contraption". And all these other contraceptives, like the implant, yes it is convenient and you can use it for a long period of time but the problem is that once you put it in there are not many professionals who are able to remove it. So again now it becomes a barrier, it becomes an issue.

5. We've learnt that men are unavailable/missing when it comes to studies like this one. What do you think needs to be done to get them involved? Do we give up on them and continue focusing on women?

No we don't give up on them, let's make them sensitive to the cause because they think that baby making is just women's business. They leave the issue at conception, then after that it's not their problem. Let's make them understand it is their problem and even make them responsible what they now call "family planning". Let's make them understand that some of these traditions sometimes have to be put aside and make it a whole family problem.

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