To use or not to use a condom: A prospective cohort study comparing contraceptive practices among HIV-infected and HIV-negative youth in Uganda

Abstract

BackgroundUnwanted pregnancy and HIV infection are issues of significant concern to young people. Limited data exists on contraceptive decision-making and practices among HIV-infected and HIV-negative young people in low resource settings with generalized HIV epidemics.MethodsFrom July 2007 until April 2009, we recruited, and followed up over a one year period, a cohort of 501 HIV-negative and 276 HIV-infected young women and men aged 15-24 years residing in Kampala and Wakiso districts. We compared contraceptive use among HIV-infected and HIV-negative young people and assessed factors associated with contraceptive decision-making and use, using multivariate logistic regression modelling to estimate odds ratios (OR) and 95% confidence intervals (CI).ResultsContraceptive use among sexually active HIV-infected young people was 34% while it was 59% among the HIV-negative group. The condom was the most frequently used method of contraception. Only 24% of the HIV-infected used condoms consistently compared to 38% among the negative group OR 0.56 (95% CI 0.38, 0.82). HIV-infected young people were more likely to discuss safe sex behaviour with health workers OR 1.70 (95% CI 1.13, 2.57), though its effect on fertility decision-making was not significant. Throughout the year's follow-up, only 24% among the HIV-negative and 18% among the HIV-infected continued to use contraception while 12% and 28% among the HIV-negative and infected respectively did not use contraception at all. At multivariate analysis, the HIV-infected young people were less likely to maintain contraceptive use. Other factors independently associated with sustained contraceptive use were age of the respondent, marital status and being a male. Conversely, HIV-infected young people were less likely to initiate use of contraception. Being married or in a relationship was associated with higher odds of initiating contraceptive use.ConclusionCompared to the HIV-negative group, sexually active HIV-infected young people are less likely to use contraception and condoms. Initiating or sustaining contraceptive use was also significantly less among the HIV-infected group. Strengthening family planning services and developing new innovative ideas to re-market condom use are needed. Policy and guidelines that empower health workers to help young people (especially the HIV infected) express their sexuality and reproduction should urgently be developed.

Fertility desire among HIV-positive women in Tigray region, Ethiopia: implications for the provision of reproductive health and prevention of mother-to-child HIV transmission services

“…This finding is lower than findings from similar studies in Swaziland, 60% [24]; Uganda, 59% [9] and 72% [30]; and Canada, 69% [4]; while it is higher than the figures derived from studies conducted in Tanzania, 36% [14]; Uganda, 10% [12], 19% [31], and 29% [11] and Malawi, 17% [5]. In Ethiopia, various studies have reported different level of fertility desire.…”

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

“…Their median age was 39 years (range 27-55), 95% were married, 50% had secondary school or higher education, and 90% were currently on ART. They had a median of four living children (range [1][2][3][4][5][6][7][8], and 95% of the men indicated they or their partner were using a contraceptive method, with 28% indicating dual method use, using condoms along with a more effective contraceptive method (see Table 1). …”

“…3 The need and desire for FP services is substantial among HIV-positive persons in both resource-limited [4][5][6][7][8][9][10] and resource-rich [11][12][13][14] settings. The unmet need for FP services is particularly high in Kenya; one study found that nearly 70% of HIV-positive women in western Kenya indicate wishing to delay their fertility for another 2 years or not have any further children.…”

The role of family planning in elimination of new pediatric HIV infection

“…Exceptions to this trend include two studies that showed lower contraceptive use among HIV-infected youth and HIV-infected female sex workers compared to their HIV-uninfected counterparts. [20, 33] Factors associated with contraceptive use by people living with HIV are similar to those identified for the general population, and are primarily not related to HIV status [14, 24, 27, 30, 31, 34]. However, one study reported that fear of ART interactions was a reason for not using contraception and another indicated that beliefs about a lower survival rate for HIV-infected children was a reason for use [14, 26].…”

“…Those who do not wish to become pregnant can be supported to access and use contraception. Though fertility desire may increase for some women after starting ART, recent data suggest that on average HIV-infected women tend to want fewer children than HIV-uninfected women [19, 20, 21*]. In one study, HIV status was the firmest predictor of not wanting future children [21].…”