HIV/AIDS and Contraceptive Method Choice: Demographic and Socio-Economic Correlates of Contraceptive Method Choice Among HIV-Positive Women Practising Family Planning in Kenya
DOI:
https://doi.org/10.17140/HARTOJ-3-119Keywords:
HIV-positive women, Contraceptive method choice, Demographic and socio economic correlates, Multinomial regression analysis, Demographic and health survey, KenyaAbstract
Introduction: As the generalized HIV epidemic in specific settings of sub-Saharan Africa continues to evolve, there is need for evidence-based response to address emerging challenges, which include enabling the large number of women living with HIV make informed choices to achieve their reproductive goals.
Objectives: This paper seeks to (i) examine the effect of HIV/AIDS on contraceptive method choice among women using contraceptives in Kenya; and (ii) identify correlates of contraceptive method choice among HIV-positive women practising family planning.
Material and Methods: We apply multinomial Logistic regression models to a sample of 3190 sexually-active women of reproductive age using contraceptives from the 2003 and 2008 Kenya Demographic and Health Surveys to examine the effect of HIV/AIDS on contraceptive method choice. The analysis of correlates of method choice among HIV-positive women is based on a sample of 255 HIV-positive women using contraceptives and involves bivariate cross-tabulations with Chi-Square tests.
Result: Overall association between HIV status and contraceptive method choice is consistent with expected patterns, with women who are HIV-positive being more than twice as likely to use condoms rather than hormonal contraceptives, compared to their counterparts of similar characteristics who are HIV-negative (p<0.05). Among women infected with HIV, those who were previously tested for HIV were more likely to use condoms and less likely to use hormonal methods (p<0.05) than those who had never been tested. The higher use of condoms by HIV-positive women is only evident among those who had previously been tested for HIV. Significant correlates of contraceptive method choice among HIV-positive women include parity, marital status, age group, education and ethnicity. Overall trends suggest a notable shift from use of hormonal methods to condoms by HIV-positive women, but predominant use of hormonal methods (60%) and low use of condoms (23%) by HIV-positive young women aged 15-24 practising family planning is of potential concern.
Conclusion: The findings have important implications for family planning policies/programs targeting young women living with HIV and underscore the need to intensify efforts towards improved HIV testing coverage to enable HIV-positive women make informed reproductive choices.
References
National AIDS and STI Control Programme (NASCOP), Min-istry of Health. Kenya AIDS Indicator Survey 2012: Final Re-port. Nairobi, NASCOP. 2014. Web site. http://www.nacc.or.ke/ images/documents/KAIS-2012.pdf. Accessed March 24, 2016.
Magadi MA, Agwanda A. Investigating the association between HIV/AIDS and recent fertility patterns in Kenya. Soc Sci Med. 2010; 71(2): 335-344. doi: 10.1016/j.socs-cimed.2010.03.040
Maina WK, Kim AA, Rutherford GW, et al. Kenya AIDS In-dicator surveys 2007 and 2012: Implications for public health policies for HIV prevention and treatment. J Acquir Immune Defic Syndr. 2014; 66(Suppl 1): S130-S137. doi: 10.1097/ QAI.0000000000000123
National AIDS Control Council (NACC) and National AIDS and STI Control Programme (NASCOP). The Kenya AIDS Epidemic Update 2011. Nairobi, Kenya. 2012. Web site. http:// www.unaids.org/sites/default/files/en/dataanalysis/knowyour-response/countryprogressreports/2012countries/ce_KE_Narra-tive_Report.pdf. Accessed March 24, 2016.
Schaan MM, Taylor M, Marlink R. Reproductive behaviour among women on antiretroviral therapy in Botswana: mis-matched pregnancy plans and contraceptive use. Afr J AIDS Res. 2014; 13(3): 305-11. doi: 10.2989/16085906.2014.952654
Kimani J, Warren C, Abuya T, Mutemwa R, Mayhew S, Askew I. Family planning use and fertility desires among women living with HIV in Kenya Global health. BMC Public Health. 2015; 15(1): 909. doi: 10.1186/s12889-015-2218-z
Siveregi A, Dudley L, Makumucha C, Dlamini P, Moyo S, Bhembe S. Does counselling improve uptake of long-term and permanent contraceptive methods in a high HIV-prevalence set-ting? Afr J Prim Health Care Fam Med. 2015; 7(1): E1-E9. doi: 10.4102/phcfm.v7i1.779
Hefron R, Donnell D, Rees H, et al. Use of hormonal con-traceptives and risk of HIV-1 transmission: a prospective co-hort study. Lancet Infect Dis. 2012; 12(1): 19-26. doi: 10.1026/ s1473-3099(11)70247-x
Ralph LJ, Gollub EL, Jones HE. Hormonal contraceptive use and women’s risk of HIV acquisition: Priorities emerging from recent data. Curr Opin Obstet Gynecol. 2015; 27(6): 487-495. doi: 10.1097/GCO.0000000000000228
Brady M. Preventing sexually transmitted infections and un-intended pregnancy, and safeguarding fertility: Triple protection needs of young women. Reprod Health Matters. 2003; 11(22): 134-141. doi: 10.1016/S0968-8080(03)02289-4
Berer M. Dual protection: more needed than practised or un-derstood. Reprod Health Matters. 2006; 14(28): 162-170. doi: 10.1016/S0968-8080(06)28262-4
Williamson NJ, Liku K, Loughlin Mc, Nyamongo I, Nakayi-ma F. A qualitative study of condom use among married couples in Kampala, Uganda. Reprod Health Matters. 2006; 14(28): 89- 98. doi: 10.1016/S0968-8080(06)28268-5
Heikinheimo O, Lahteenmaki P. Contraception and HIV in-fection in women. Hum Reprod Update. 2009; 15(2): 165-176. doi: 10.1093/humupd/dmn049
Magadi MA, Curtis S. Trends and determinants of contra-ceptive method choice in Kenya. Stud Fam Plann. 2003; 34(3): 149-159. doi: 10.1111/j.1728-4465.2003.00149.x
Seiber EE, Bertrand JT, Sullivan TM. Changes in contra-ceptive method mix in developing countries. Int Fam Plan Per-spect. 2007; 33(3): 117-123. Web site. https://www.guttmacher. org/about/journals/ipsrh/2007/09/changes-contraceptive-meth-od-mix-developing-countries. Accessed March 24, 2016
Kenya National Bureau of Statistics (KNBS) and ICF Mac-ro. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. 2010. Web site. http://dhspro-gram.com/pubs/pdf/fr229/fr229.pdf. Accessed March 24, 2016.
Lopez LM, Hilgenberg D, Chen M, Denison J, Stuart G. Be-havioral interventions for improving contraceptive use among women living with HIV. Cochrane Database Syst Rev. 2013; 1: CD010243. doi: 10.1002/14651858.CD010243.pub2
Imbuki K, Todd CS, Stibich MA, Shaffer DN, Sinei SK. Factors influencing contraceptive choice and discontinuation among HIV-positive women in Kericho, Kenya. Afr J Reprod Health. 2010; 14(4): 98-109. Web site. http://www.bioline.org. br/pdf?rh10070. Accessed March 24, 2016.
Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Keya], and ORC Macro. Kenya Demographic and Health Survey 2003, Calverton, Maryland. 2004. Web site. http://www.dhsprogram.com/pubs/pdf/FR151/FR151.pdf. Ac-cessed March 24, 2016.
Rutstein, SO, Johnston K. The DHS Wealth Index. DHS Comparative Reports. No.6. ORC Macro, Calverton, Maryland USA. 2004. Web site. http://www.childinfo.org/files/DHS_ Wealth_Index_(DHS_Comparative_Reports).pdf. Accessed March 24, 2016.
Church K, Wringe A, Fakudze P, et al. Reliance on condoms for contraceptive protection among HIV care and treatment cli-ents: A mixed methods study on contraceptive choice and moti-vation within a generalised epidemic. Sex Transm Infect. 2014; 90(5): 394-400. doi: 10.1136/sextrans-2013-051339
Phillips SJ, Polis CB, Curtis KM. The safety of hormonal contraceptives for women living with HIV and their sexual part-ners. Contraception. 2016; 93(1): 11-16. doi: 10.1016/j.contra-ception.2015.10.002
Balkus JE, Brown ER, Hillier SL, et al. Oral and injectable contraceptive use and HIV acquisition risk among women in four African countries: A secondary analysis of data from a micro-bicide trial. Contraception. 2016; 93(1): 25-31. doi: 10.1016/j. contraception.2015
Obare F, van der Kwaak A, Birungi H. Factors associated with unintended pregnancy, poor birth outcomes and post-par-tum contraceptive use among HIV-positive female adolescents in Kenya. BMC Women’s Health. 2012; 12: 34. doi: 10.1186/1472- 6874-12-34
Magadi MA, Desta M. A multilevel analysis of the determi-nants and cross-national variations of HIV seropositivity in sub-Saharan Africa: evidence from the DHS. Health Place. 2011; 17(5): 1067-1083. doi: 10.1016/j.healthplace.2011.06.004
Schwartz SR, Rees H, Mehta S, Venter WDF, Taha TE, Black V. High incidence of unplanned pregnancy after antiretro-viral therapy initiation: Findings from a prospective cohort study in South Africa. PLoS ONE. 2012; 7(4): e36039. doi: 10.1371/ journal.pone.0036039
Raifman J, Chetty T, Tanser F, et al. Preventing unintended pregnancy and HIV transmission: Effects of the HIV treatment cascade on contraceptive use and choice in rural Kwa Zulu-Na-tal. J Acquir Immune Defic Syndr. 2014); 67(4): S218-S227. doi: 10.1097/QAI.0000000000000373
Antelman G, Medley A, Mbatia R, et al. Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania. J Fam Plann Reprod Health Care. 2015; 41(1): e1. doi: 10.1136/ jfprhc-2013-100784
Roxby AC, Ben-Youssef L, Marx G, et al. Dual contracep-tive method use in HIV-serodiscordant Kenyan couples. J Fam Plann Reprod Health Care. 2016 pii: jfprhc-2015-101233. doi: 10.1136/jfprhc-2015-101233
Habte D, Namasasu J. Family planning use among wom-en living with HIV: knowing HIV positive status helps - re-sults from a national survey. Reprod Health. 2015; 12: 41. doi: 10.1186/s12978-015-0035-6
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in HIV/AIDS Research and Treatment (HRT) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
