Mirror, mirror on the wall: the face of HIV + women in Europe today

Abstract

Sexual and reproductive health (SRH) and rights are important components of quality of life. This cross-sectional study describes HIV-positive women's SRH aspirations and needs and the predictive value of selected SRH factors on condom use with steady sexual partners. Data were collected in a European multi-centre study in 17 HIV centres in 14 European countries by a standardised anonymous self-administered questionnaire. Descriptive statistics and hierarchical regression analysis were carried out and qualitative data from related formative research illustrated the findings. Among 387 HIV-positive women, 57% had children and 35% had become pregnant since their HIV-diagnosis. Contraceptive needs were largely unmet: 14% had undergone a pregnancy termination. About 83% changed their sexual behaviour after HIV-diagnosis in some ways. Sixty-two percent had at least one sexual encounter with a steady partner during the past six months and 51% used condoms consistently. Significant correlations with condom use were identified for childbearing since HIV-diagnosis (r=-0.21, p<0.01), miscarriage since HIV-diagnosis (r=-0.24, p<0.01), the use of contraception (r=0.47, p<0.001) and changes in sexual behaviour after HIV-diagnosis (r=0.20, p<0.01). Hierarchical regression analysis controlled for education, migration background, age, undetectable viral load and partners' serostatus. The following significant predictors for condom use were established: the use of contraceptives (beta=0.33, p<0.001); miscarriage since HIV-diagnosis (beta=-0.16, p<0.01); childbearing since HIV-diagnosis (beta=-0.12, p<0.05); and having an HIV-positive partner (beta=-0.13, p<0.05). For study population, consistent condom use performed a challenge. Selected SRH-issues predicted condom use. Sexual risk reduction and positive prevention should be discussed in the context of family planning and integrate SRH perspectives in routine HIV care.

Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011

“…The messages promoting dual method protection might be perceived as ambiguous, as illustrated by the lower use of condoms with a nonpositive partner by women using highly effective contraception. Such findings are consistent with previous studies [12,24,36] and emphasize the need for sexual health counseling to address both contraception and protection against HIV transmission and STIs' issues.…”

“…Consistent with previous studies across a range of countries [24][25][26][27][28], the distribution of contraceptive methods differs markedly among HIV-positive women compared to the general population, with a large predominance of condom use among HIV-positive women and a very low rate of use of highly effective methods, including either oral hormonal contraception or the IUD. The proportion of women reporting both HEC and condom as a contraception method was small and in the same range as reported in other western countries: 8.8% in the VESPA2 study, 12% in a convenience sample of European women [12] and 16% of adolescent and young HIV-positive women in the United States [29].…”

“…Several studies have noted the lack of open discussion initiated by HIV care specialists about sexual and reproductive health issues, with most discussions being initiated by the patient [12,32,37]. The authors of these studies have suggested that HIV care specialists have limited skills to properly address sexual and reproductive health issues [32].…”

“…Condoms have been found to be the most widespread contraception method among women living with HIV in western countries; however, the inconsistent use of condoms remains widespread [9], and the use of highly effective methods has remained rare [10]. Above all, high rates of unintended pregnancy have been registered among women living with HIV (ranging from 50% to 85%) [11][12][13], suggesting unmet needs for contraception.…”

HIV-Related Discrimination in European Health Care Settings

“…Details on the methodology of this observational and cross-sectional study were described elsewhere. 13 All study participants (N = 1549) provided informed written consent. Data were collected between 03-10/2007.…”