Dual Contraceptive Method Use in HIV-Serodiscordant Kenyan Couples

BACKGROUND:

World Health Organization (WHO) guidelines recommend dual contraceptive method use with condoms and another contraceptive to reduce both incidence of HIV/sexually transmitted infection transmission and unintended pregnancies. This qualitative study assessed the barriers to and motivations for dual contraceptive use in Kenyan HIV-serodiscordant couples.

METHODS:

HIV-serodiscordant couples in Nairobi, Kenya, were recruited from two longitudinal cohorts. Qualitative semistructured interviews were conducted using a semistructured questionnaire. Twelve male and 12 female members of serodiscordant couples and 10 women with incident pregnancies during the cohort studies were included.

RESULTS:

Few couples reported using dual contraceptive methods, with men reporting more condom use than women. No HIV-seropositive men or HIV-seronegative women reported using non-condom contraception. Men and women agreed that men play a dominant role in decisions to use both condoms and contraception in HIV-serodiscordant couples. Participants reported that perceptions of side effects, male partner preference, and reproductive desire were critical factors in contraceptive decisions. Both men and women saw dual contraceptive method use as redundant and a sign of possible unfaithfulness. Many participants actively desired pregnancy, but few were able to accurately define monthly fertility windows.

CONCLUSIONS:

Dual contraceptive method use was low in these HIV-serodiscordant couples, with some couples finding it unnecessary while using condoms, and others being more focused on conceiving a child. Biomedical HIV prevention, including male circumcision, pre-exposure prophylaxis or antiretroviral therapy to reduce HIV transmission, may be more acceptable strategies to promote safer sexual relations among HIV-serodiscordant couples and safer conception when desired.

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By:  Roxby AC1, Ben-Youssef L2, Marx G3, Kinoti F4, Bosire R4, Guthrie B5, Mackelprang R6, Kiarie J7, John-Stewart G8, Farquhar C9.

• 1Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA.
• 2Resident Physician, Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA, USA, and University of Washington School of Medicine, WA, USA Infectious Disease Fellow, Department of Medicine, University of Colorado, Aurora, CO, USA.
• 3Physician, Kenya Medical Research Institute, Nairobi, Kenya.
• 4Senior Clinical Research Scientist, Kenya Medical Research Institute, Nairobi, Kenya.
• 5Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA.
• 6Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA.
• 7Acting Instructor, Department of Global Health, University of Washington, Seattle, WA, USA Professor, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya and Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.
• 8Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA Professor, Departments of Medicine, Global Health, Pediatrics, and Epidemiology, University of Washington, Seattle, WA, USA Professor, Departments of Medicine, Epidemiology, Global Health, University of Washington, Seattle, WA, USA.
• 9Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA Professor, Departments of Medicine, Epidemiology, Global Health, University of Washington, Seattle, WA, USA. 

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Dual Contraceptive Method Use & Pregnancy Intention among People Living with HIV Receiving HIV Care at Six Hospitals in Thailand

Background

Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand.

Methods

From January 2008–March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2–3 months to promote the use of dual contraceptives and were offered family planning services.

Results

A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33–43), 898 (64.7 %) had a steady partner, and 737 (53.1 %) were male. Among those with a steady partner, 862 (96.0 %) did not intend to become pregnant; 709 (82.3 %) had sex during the previous 3 months, 683 (96.3 %) used at least one contraceptive method, and 202 (29.6 %) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8 %) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03).

Conclusion

Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use.

Below:  Pregnancy desire assessment and family planning short messages

Full article at:  http://goo.gl/PZxrPH

By:  Warangkana Munsakul¹, Rangsima Lolekha^2*, Boonchai Kowadisaiburana³, Anuvat Roongpisuthipong⁴, Supannee Jirajariyavej⁵, Suvanna Asavapiriyanont⁶, Ubonsri Hancharoenkit⁷, Benjamas Baipluthong², Sarika Pattanasin² and Michael Martin²⁸

*Corresponding author: Rangsima Lolekha hpu8@cdc.gov

¹Faculty of Medicine Vajira Hospital, Navamindharadhiraj University, Bangkok, Thailand

²Thailand Ministry of Public Health-U.S. Center for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand

³Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand

⁴Siriraj Hospital, Mahidol University, Bangkok, Thailand

⁵Taksin Hospital, Bangkok, Thailand

⁶Rajavithi Hospital, Bangkok, Thailand

⁷Wiang Pa Pao Hospital, Chiang Rai, Thailand

⁸Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, USA

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Structural Determinants of Dual Contraceptive Use among Female Sex Workers in Gulu, Northern Uganda

To describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda.

The present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14years or older were recruited through peer-led or sex worker-led outreach and community-based services. Logistic regression was used to identify correlates of dual contraceptive use.

Among the 400 FSWs who participated, 180 (45.0%) had ever used dual contraceptives. In the multivariate model, dual contraceptive use was positively associated with older age, prior unintended pregnancy, and HIV testing. Having to rush sexual negotiations owing to police presence was negatively associated with dual contraceptive use.

Although a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.

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By: Erickson M1, Goldenberg SM1, Ajok M2, Muldoon KA1, Muzaaya G2, Shannon K3.

• 1Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
• 2The AIDS Support Organization, Gulu, Uganda.
• 3Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. Electronic address: gshi@cfenet.ubc.ca.  

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