A Prospective Study of Contraceptive Use Among African Women in HIV-1 Serodiscordant Partnerships

Sex Transm Dis. 2010 Oct;37(10):621-8. doi: 10.1097/OLQ.0b013e3181e1a162.

Abstract

Background: Dual contraception is important for averting HIV-1 transmission, unintended pregnancy, and maternal-to-child HIV-1 transmission. Few studies have explored contraceptive use in HIV-1 serodiscordant couples, a population at high risk for HIV-1 transmission.

Methods: Data from a prospective study of 3407 women in HIV-1 heterosexual serodiscordant partnerships were analyzed to describe use and correlates of contraception.

Results: Among 2298 HIV-1 seropositive women, 23.5% used contraception at enrollment and 30.2% used contraception after 24 months of follow-up; among 1109 HIV-1 seronegative women, contraceptive use decreased from 21.3% to 14.2%. For both HIV-1 seropositive and seronegative women, contraceptive use was less common among women from East Africa compared to women from southern Africa (adjusted odds ratio [AOR], 0.6; 95% confidence interval [CI], 0.5-0.8 and AOR, 0.6; 95% CI, 0.4-0.8, respectively) and more common among women with at least one child (AOR, 2.4; 95% CI, 1.7-3.4 and AOR, 2.3; 95% CI, 1.2-4.5, respectively). Condom use increased significantly during follow-up from 71.2% to 92.6% and 73.5% to 95.6% among HIV-1 seropositive and HIV-1 seronegative women, respectively, at baseline and 24 months. However, contraceptive use was associated with unprotected sexual activity among both HIV-1 seropositive and seronegative women (AOR, 1.3; 95% CI, 1.1-1.5 and AOR, 1.4; 95% CI, 1.1-1.8, respectively), although not among women who initiated contraception during follow-up.

Conclusions: Counseling and provision of dual contraception should receive high priority in programs that care for women in HIV-1 serodiscordant partnerships.

MeSH terms

  • Adolescent
  • Adult
  • Africa
  • Africa, Eastern
  • Africa, Southern
  • Condoms / statistics & numerical data*
  • Contraceptive Agents / administration & dosage*
  • Female
  • HIV Infections / prevention & control*
  • HIV Seronegativity*
  • HIV-1*
  • Heterosexuality
  • Humans
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Safe Sex / statistics & numerical data*
  • Sexual Partners

Substances

  • Contraceptive Agents