The influence of partnership on contraceptive use among HIV-infected women accessing antiretroviral therapy in rural Uganda
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Date
2015Author
Nieves, Christina I.
Kaida, Angela
III, George R. Seage
Kabakyenga, Jerome
Muyindike, Winnie
Boum, Yap
Mocello, A. Rain
Martin, Jeffrey N.
Hunte, Peter W.
Haberer, Jessica E.
Bangsberg, David R.
Matthews, Lynn T.
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Objective: The objective was to determine individual and dyadic factors associated with effective contraceptive use among human immunodeficiency virus (HIV)-infected women accessing antiretroviral therapy (ART) in rural Uganda.
Study design: HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing socio-behavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires) and phlebotomy (October 2011–March
2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous 6 months among sexually active, non-pregnant women (18–40 years). We assessed covariates of contraceptive use using multivariable logistic regression.
Results: A total of 362 women (median values: age 30 years, CD4 count 397 cells/mm3, 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire (another) child, and 51% had a Sero-concordant partner. Forty-five percent (n=127) reported effective contraceptive use, of whom 57% (n=72) used condoms, 42% (n=53) injectable, 12% (n=15) oral contraceptives and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only “partnership fertility desire” was independently associated with contraceptive use; women who reported that neither partner desired a child had significantly increased odds of contraceptive use (adjusted odds ratio: 2.40, 95% confidence interval: 1.07–5.35) compared with women in partnerships where at least one partner desired a child.
Conclusions: Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer-acting female controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming
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