Differences in the Access to Sterilization between Women Living and Not Living with HIV: Results from the GENIH Study, Brazil

Abstract

BackgroundIn many countries, young women of reproductive age have been especially affected by the HIV epidemic, which have fostered research to better understand how HIV infection influences and shapes women´s fertility and reproductive and sexual decisions. In Brazil, few studies have focused on the impact of the HIV epidemic on contraceptive choices among women living with HIV (WLHIV).ObjectiveThis study evaluates the impact HIV infection may have in the access to female sterilization in Brazil, using a time-to-event analysis.MethodsA cross-sectional quantitative study (GENIH study) was conducted between February 2013 and April 2014 in the city of São Paulo, comparing two probabilistic samples of 975 WLHIV and 1,003 women not living with HIV (WNLHIV) aged 18 to 49. Sexual and reproductive data was collected retrospectively in order to reconstruct women's reproductive trajectories. Given the objectives of this study, the analysis was restricted to women with parity one or more and, in case of WLHIV, to those sterilized after HIV diagnosis and not infected through vertical transmission. The final sample analysis included 683 WNLHIV and 690 WLHIV. A series of multivariable-adjusted Cox models estimated the probability of being sterilized after HIV diagnosis, compared with WNLHIV. Models were adjusted for schooling, race/color, and stratified by parity at last delivery (1–2, 3+). Hazard ratios were calculated for female sterilization, and separately for interval and postpartum procedures (performed in conjunction with caesarean section or immediately after vaginal delivery). Additionally, information regarding unmet demand for female sterilization was also explored.FindingsNo statistical difference in the overall risk of sterilization between WLHIV and WNLHIV in the two parity-related groups is observed: HR = 0.88 (0.54–1.43) and 0.94 (0.69–1.29), respectively, among women with 1–2 children and those with three and more. However, significant differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV.ConclusionThe results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV’s eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection stra...

Access to sexual and reproductive health services for women living with HIV in Latin America and the Caribbean: systematic review of the literature

“…Three quantitative studies in Brazil concluded that WLHIV used condoms as the sole contraceptive method more often than WNLHIV (60% vs. 56% respectively) , with similar results found by the two other single‐group studies ; one conducted in Brazil (62% of condom use) and one in Argentina (74% of condom use).…”

“…A total of 18 studies were included, of which 10 were conducted in South America , four in Mesoamerica , two in the Caribbean and two multicentric , totalling 5,672 WLHIV from 13 LAC countries (Table ).…”

“…Nevertheless, this review showed that WLHIV represents an age group ranging between 25 and 35 years, have an average‐low education (five to seven years), have at least one child, work mainly in the informal sector (medium‐low income) and are not living with a partner. The ethnicity of the participants included black and other Afro‐descendants, mestizo, white and indigenous populations .…”

“…WLHIV are vulnerable to unfavourable physical, social and economic factors, which operate at multiple levels and are aggravated by gender inequalities that persist in the Region . In the LAC, evidence for the barriers that WLHIV face regarding access and use of SRHS are scarce and have been reported primarily from individual studies conducted in Brazil, Argentina and Mexico , but a systematic review focusing on LAC has not been performed. This article presents the results of a systematic review of the literature regarding the use and access of SRHS for WLHIV in LAC to provide an overview of the needs of these women and to help define new and/or adapt existing public health strategies to the local context.…”

Saberes de puérperas sobre o planejamento reprodutivo

“…Acredita-se que para a definição do método é necessário que o profissional de saúde demonstre, durante o atendimento, a possibilidade de escolha livre, devendo ocorrer de maneira informada e com oferta satisfatória de métodos, além de competência técnica para realizar atividades educativas e de aconselhamento necessárias, reforçando o autocuidado como meio de manutenção das práticas preventivas, ao mesmo tempo em que conduz o sujeito ou o casal para o protagonismo de seu planejamento reprodutivo (BARBOSA et al, 2016).…”