Linking HIV & family planning services to improve dual methods of contraception among women infected with HIV in Mumbai, Maharashtra, India (original) (raw)
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Infectious Diseases in Obstetrics and Gynecology, 2011
Objective. To describe the prevalence and correlates of dual-contraceptive methods use (condomsandaneffectivepregnancy prevention method) and barriers to their use among married persons living with HIV (PLHIV) in India.Methods. We conducted a quantitative survey (93 men, 97 women), 25 in-depth interviews, seven focus groups, and five key informant interviews.Results. Prevalence of dual- contraceptive method use increased from 5% before HIV diagnosis to 23% after diagnosis (P < 0.001). Condoms were the most common contraceptive method, with prevalence increasing from 13% before diagnosis to 92% after diagnosis (P < 0.001). Barriers to using noncondom contraceptives were lack of discussion about noncondom contraceptives by health care providers, lack of acceptability of noncondom contraceptives among PLHIV, and lack of involvement of husbands in family planning counseling.Conclusion. There is a need for interventions, including training of health care providers, to increase dual...
Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai
Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine
Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program's potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people. To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV. A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire. In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual ...
Clinical Epidemiology and Global Health , 2021
Background: HIV/AIDS epidemic is one of the most serious global public health problems, more particularly seen in low and middle-income countries. Females contribute around 40% of total HIV cases in India who predominantly belong to fertile age group. This study aimed to assess the contraceptive utilization patterns and factors affecting the HIV-positive Indian women. Methods: A cross-section of 400 confirmed HIV-positive women aged between 18 and 45 years were recruited. All the relevant information including socio-demographic and anthropometric details were collected from the participants. All other needed parameters were recorded from patients file. The SPSS ver. 21 was used to perform statistical analysis. Results: The mean age of the participants was found to be 29.53 ± 5.35 years. The majority of women were housewives (97%), Illiterate (58.8%) and 90.5% had a monthly family income under 10,000 INR. Maximum (82.8%) of HIV transmission was found through unprotected sexual routes while 68.8% of patients were on HAART. Male condoms were highly utilized whereas 44.3% of participants never used any methods. Percentage of consistent contraceptive use was highest when patients were educated to graduate level (66.7%), aware of contraception methods (49.8%) and who have a monthly income more than 20,000 INR (66.7%). Conclusion: This study gives a real picture of the contraceptive utilization among HIV-infected women from rural regions of India. The study anticipates the immediate needs in healthcare sector to improve awareness of patients regarding modern methods of contraception and effective family planning strategies.
2020
Background HIV is a major global health issue, targeting the immune system and making the body prone to diseases. People living with HIV mostly face societal stigma and fear of disclosure resulting in discrimination of accessing health facilities leading to multiple sex partners, increased sexual activity and less use of condoms. HIV positive women are at risk of transmitting HIV to their infants and their partners. Thus, the family planning services if provided to PLHIV can help to improve their and families health. In addition to, it reduces the risk of mother-to-child transmission (PMTCT). The facts related to PLHIV with respect to pregnancy and childbearing are not available. The purpose of this study is to focus on the status of the use of family planning methods and explore factors affecting the utilization among people living with HIV and AIDS in Kathmandu valley of Nepal. The study is expected to contribute in enhancing the present understanding of PLHIV towards family planning. Methods The cross sectional descriptive method was used for the research. The study followed Population proportion to size method for the calculation of the respondents from four ART sites of Kathmandu Valley. Structured questionnaire used previously in similar research has been adopted with necessary question related to dual contraceptive use. Results The mean age group of the respondents was (39.16 ± 6.969) years. More than two third respondents (69.5%) were Hindu. 34.8% respondents were married at the less than 20 years of age. Almost three-fourth of the PLHIV (74.4%) were literate where more than three fourth (79.3%) their spouses were literate and educated. About half of the respondents (43.9%) were found to be involved in professional/ technical/ managerial. More than half of the respondent's spouses (63.4%) were HIV positive. All the respondents (100%) respondents had disclosed their status to their partners. Neither the respondents nor their partner had fertility desire. 28% of neither respondents nor their partners had used the family planning methods before HIV diagnosis. More than half (60.4%) of the respondents had sexual intercourse prior to last 6 months. 15.9% of the respondents positively responded to use of dual protection. Only 11% either respondents or their partners had used the emergency contraceptive pill. 17.7% respondents did not use any family planning. This study revealed that almost half of the respondents (48.8%) had the good knowledge on the use of contraception. Conclusion The use of dual protection is much less than the half of the respondents. Therefore, counseling and health education towards motivating PLHIV on using dual FP methods to avoid the risk of HIV, STIs and unplanned pregnancy is encouraged.
International Journal Of Community Medicine And Public Health
Background: HIV testing and treatment of seropositive pregnant mothers is a much focused and efficiently managed programme as part of convergence plan between National AIDS Control Program and Reproductive and Child Health services under National Health Mission. This paper aims to depict the level of convergence that exists for another most important reproductive health service namely family planning (FP) for PLHIV at public healthcare settings in Maharashtra. Methods: Participatory observations of HIV, FP and STI facilities and key informant interviews of providers at these facilities located in selected secondary (two district hospitals) and tertiary (two teaching hospitals) public hospitals in Maharashtra were conducted as part of larger intervention study. Results: Insufficient health workforce with inadequate knowledge about PLHIV’s eligibility for contraception and discriminated service delivery (25%) was prominent. Only half (50%) key informants were conversant about FP couns...
AIDS Care, 2015
This study examines the prevalence, reasons and predictors of unwanted pregnancies and induced abortions among ever married HIV infected women attending a care facility in Maharashtra, Western India and discusses its programmatic and policy implications. Retrospectively collected data of pregnancies conceived after the diagnosis of HIV were analyzed using descriptive and logistic regression techniques. Among the 622 women interviewed, 113 women had 158 pregnancies with known outcomes after HIV diagnosis. Among these 80 (51%) were unwanted and 79 (50%) were voluntarily terminated. Fear of transmitting HIV to the child was a frequently mentioned reason for unwanted pregnancy (71.8%) and induced abortion (59.5%). Women from urban area [OR 2.43(95% CI 1.23-4.79)] and with two or more live births before HIV diagnosis [OR 3.33(95% CI 1.36-8.20)] were significantly more likely to report unwanted pregnancy. Women with two or more live births before HIV diagnosis [OR 3.16(95% CI 1.20-8.35)], who did not know that HIV transmission to the baby can be prevented [OR 3.29(95% CI 1.48-7.34)] and with an unwanted pregnancy [OR 4.82(95% CI 2.33-10.00)] were significantly more likely to terminate the pregnancy. Despite of increased coverage of antiretroviral treatment, effective provision of reproductive health care services to HIV infected women remain challenging. High prevalence of unwanted pregnancies and induced abortion and low level of knowledge about PMTCT underscores the need for preconception counseling and provision of comprehensive family planning services to HIV infected women. Enrolling all HIV infected pregnant women, irrespective of their decision to continue pregnancy, in PMTCT program and discussing with HIV infected women and their partners at HIV diagnosis a full array of contraceptive methods and not just consistent use of condoms might be helpful in reducing unwanted pregnancies.
2021
Background People living with HIV (PLHIV) receive free antiretroviral treatment (ART) in public health facilities of India. With improved life expectancy, unmet sexual and reproductive health needs of PLHIV have to be addressed through a converged programmatic response strategy. Evidence shows that socioeconomically disadvantaged women are most vulnerable to high reproductive morbidities, especially HIV positive women with an unmet need of contraception. Methods Programmatic convergence by linking ART and family planning services were strengthened at two public health facilities (district hospitals) generally accessed by disadvantaged socio-economic sections of the society. Barriers to linking services including stigma and discrimination were addressed through analysis of existing linkage situation, sensitization and training of healthcare providers and system-level interventions. This facilitated provider-initiated assessment of contraceptive needs of PLHIV, counseling about dual c...
Patient Preference and Adherence, 2016
Background: Integration of family planning services (FPS) into human immunodeficiency virus (HIV) care for HIV-infected women is an important aspect of the global prevention of mother-to-child transmission (PMTCT) strategy. We assessed the integration of FPS into routine care of HIV-infected mothers by evaluating the uptake and barriers of contraception and PMTCT services. Methods: We conducted an interventional study using the interrupted time series approach in the health care facilities located in Yaounde, Cameroon. First, structured questionnaires related to family planning use, PMTCT services use, and infection risk of the sexual partner were administered to the first trimester pregnant women who were HIV infected and living with uninfected partners. Second, 2 weeks before the delivery date, the women were interviewed according to the prior counseling interventions received, in order to assess their behavior on FPS, antiretroviral therapy (ART) use, delivery option, and infant nourishment to be adopted. P-values below 0.05 were considered statistically significant in the statistical analyses. Results: Of 94 HIV-infected women, 69% were stable couples. Only 13% of women had attended FPS before conception. Although the vast majority were knowledgeable about modern and traditional contraception methods, only 19% had experienced effective contraceptive methods. However, 66% preferred condom use, 45% having three children still expressed a desire to conceive, while 44% reported abortions, 65% had tried to avoid the current pregnancy, and 12% of women were ART naïve. Several predictors such as education, abortion rate, unplanned pregnancies, and partners' decision were associated with the nonuse of effective contraceptive methods. Moreover, barriers including sex inequity, lack of partner support, ART shortages, and lack of HIV viral load monitoring were prevalent among the participants (P=0.001). However FPS use, ART compliance, and safe options to PMTCT significantly increased after the educational counseling interventions (P=0.001). Conclusion: Scaling up the FPS by incorporating routine PMTCT services into reproductive health care should contribute to preventing both horizontal and vertical transmission of HIV.
Reproductive health, 2016
Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand. 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. 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 31...