Over the past 25 years, as the HIV epidemic took hold in many countries, a number of observational research studies suggested a possible increased risk of HIV acquisition for women using progestogen-only injectables, particularly DMPA-IM. Because of limitations in the design of these studies, however, it was not possible to determine whether HIV infections were due to the type of contraceptive method used or other factors. 

The ECHO Study (Evidence for Contraceptive Options and HIV Outcomes) was carried out in four countries with settings of high HIV incidence ‒ Eswatini, Kenya, South Africa and Zambia. A total of 7829 sexually active HIV-negative women aged 16 to 35 years who wanted to use a modern method of contraception were enrolled and were randomly assigned to one of the three methods.

Among the 7829 women who took part in the study, 397 HIV infections occurred. There was no statistical difference in the rate of acquisition of HIV among the women.  143 infections were in women who used DMPA-IM, 138 were in women who used a copper-bearing IUD and 116 in women who used a levonorgesterel implant.  The study therefore found no link between HIV infection and contraceptive methods. The study was reported in the Lancet on June 13, 2019.