Dual contraceptive method use and pregnancy intention among people living with HIV receiving HIV care at six hospitals in Thailand (original) (raw)
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AIDS Care, 2012
Sexual behavior of HIV-positive youths, whether infected perinatally, through risky behavior or other ways, is not substantially different from that of HIV-uninfected peers. Because of highly active antiretroviral therapy, increasing number of children, infected perinatally, are surviving into adolescence and are becoming sexually active and need reproductive health services. The objective of this article is to review the methods of contraception appropriate for HIV-positive adolescents with a special focus on hormonal contraceptives. Delaying the start of sexual life and the use of two methods thereafter, one of which is the male condom and the other a highly effective contraceptive method such as hormonal contraception or an intrauterine device, is currently the most effective option for those who desire simultaneous protection from both pregnancy and sexually transmitted diseases. Health care providers should be aware of the possible pharmacokinetic interactions between hormonal contraception and antiretrovirals. There is an urgent need for more information regarding metabolic outcomes of hormonal contraceptives, especially the effect of injectable progestins on bone metabolism, in HIV-positive adolescent girls.
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.
2013
The human immunodeficiency virus (HIV) epidemic resulted in decreased fertility among HIV-positive women, who did not want to transmit the virus to their unborn children. With the availability of antiretroviral therapy that suppresses viral load, HIV-infected women live normal lives and even acknowledge the desire and intention to have children, a factor that is rarely acknowledged in antiretroviral therapy (ART) clinic services. This study examined fertility intentions and contraception use among a sample of women attending an ART clinic in Oromia Region, Ethiopia. Methods: A quantitative, cross-sectional and descriptive design was used on a sample of 362 HIV-positive women. Data were collected using a researcher-administered questionnaire. Results: The ages of the participants ranged from 18 to 49 years and most were between the ages of 23 and 32. A desire and intention to fall pregnant was reported by 46.6% (n = 158) of the participants. A total of 114 (35.5%) had given birth after they were diagnosed with HIV and 4% were pregnant at the time of the study. Of the study participants who wanted to have children, 60.7% (n = 82) planned to have a child within two years. In the period before they were diagnosed with HIV, most participants used injectable contraceptives but this changed to using the condom after they were diagnosed with HIV. Conclusion: The high number of women who have both the desire and intention to have children among this sample of HIVpositive women requires that reproductive health services need to include family planning as an essential component of reproductive health services. The change to using the condom as a contraceptive method indicates the positive impact of health promotion received at ART clinic.
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...
Journal of The International Aids Society, 2011
Background Prevention of unplanned pregnancies among HIV-infected individuals is critical to the prevention of mother to child HIV transmission (PMTCT), but its potential has not been fully utilized by PMTCT programmes. The uptake of family planning methods among women in Uganda is low, with current use of family planning methods estimated at 24%, but available data has not been disaggregated by HIV status. The aim of this study was to assess the utilization of family planning and unintended pregnancies among HIV-infected people in Uganda. Methods We conducted exit interviews with 1100 HIV-infected individuals, including 441 men and 659 women, from 12 HIV clinics in three districts in Uganda to assess the uptake of family planning services, and unplanned pregnancies, among HIV-infected people. We conducted multivariate analysis for predictors of current use of family planning among women who were married or in consensual union and were not pregnant at the time of the interview. Results One-third (33%, 216) of the women reported being pregnant since their HIV diagnoses and 28% (123) of the men reported their partner being pregnant since their HIV diagnoses. Of these, 43% (105) said these pregnancies were not planned: 53% (80) among women compared with 26% (25) among men. Most respondents (58%; 640) reported that they were currently using family planning methods. Among women who were married or in consensual union and not pregnant, 80% (242) were currently using any family planning method and 68% were currently using modern family planning methods (excluding withdrawal, lactational amenorrhoea and rhythm). At multivariate analysis, women who did not discuss the number of children they wanted with their partners and those who did not disclose their HIV status to sexual partners were less likely to use modern family planning methods (adjusted OR 0.40, range 0.20-0.81, and 0.30, range 0.10-0.85, respectively). Conclusions The uptake of family planning among HIV-infected individuals is fairly high. However, there are a large number of unplanned pregnancies. These findings highlight the need for strengthening of family planning services for HIV-infected people.
American Journal of Nursing Science, 2015
HIV positive individuals may or may not have intention to have children. They could also have different degrees of utilization and demand for family planning. The desire of HIV infected persons to have children in the future has significant implication for the transmission of HIV to sexual partners or newborns. So this study contributes a lot for program planner or other influential people. The study was designed to determine the fertility desire and contraceptive utilization among People Living with HIV in ART follow up care in western Shoa Zone. A cross sectional institution based study design supplemented by qualitative in-depth interview was done between December to May 2012. The study was conducted in western Shoa Zone (three Hospital; Ambo, Gedo and Gindeberet hospital), western Ethiopia. The study population were all People Living with HIV who had at list one visit to the selected ARV treatment units and age group 18-49 for women and 18-59 for men and the sample size taken were 462 and data were analyzed by SPPS version 16 computer soft ware. Seventy-eight (50.3%) male and One hundred twelve (36.5%) female respondents expressed the desire for children, giving a total of 190(41.13%) of all respondents. One hundred ninety-nine (43.1%) were using family planning during the study period. Majority of the respondents 150(71.8%) using condom. Those who intended children are those who have no children, married and partner desire for children. Those who use family planning were educated (secondary and post secondary education), married, having children of three or more and those having knowledge on Mother To Child Transmission of HIV. Couples or individuals in need of children should be supported by availing adequate information on Prevention of Mother To Child Transmission service link with the country HIV prevention and control plan and strategy since high number of participants are in need of children.
The Indian journal of medical research, 2016
Preventing unintended pregnancies among people living with HIV (PLHIV) is one of the strategies of WHO for preventing parent-to-child transmission (PPTCT). Given the limitation of only condom use, the objective of this study was to improve use of dual contraceptive methods among HIV infected women. An experimental study among HIV positive women was conducted at two tertiary care level hospitals in Mumbai. Linking HIV with family planning services was the focus of intervention at one site and standard level of care was maintained at the control site. At each site, 150 HIV+ve women attending counselling and testing centres, who did not intend to get pregnant in the next one year and were eligible to use dual methods, were enrolled and followed up to one year. At the end of one year, 60 per cent women in the intervention group reached Family Planning centres compared to eight per cent in the control group. There was three times more acceptance and continuation of use of dual methods al...
Background: Family planning helps to reduce the number of high-risk births and prevent unplanned pregnancies and mother-to-child transmission of HIV. The main purpose of this study was to determine the usage of family planning and its associated factors among women living with HIV who attended care and treatment clinics. Methods: This was a health facility-based cross-sectional study conducted among 332 sexually active reproductive-age women living with HIV who visited care and treatment clinics from 15 April and 15 June 2017. We used a systematic sampling technique for sample selection. The data were collected using pretested and structured questionnaires through face-to-face interviews. Seriously ill women living with HIV who were unable to respond to the questionnaire and refused to participate were excluded from this study. Logistic regression was fitted, and an odds ratio with a 95% confidence interval with a p value less than 0.05 was used to identify factors associated with modern family planning use. Result: The study revealed that the overall use of the modern family planning method was 56.3%, and the most common method used was injectable (37.4%) followed by implants (28.9%). About 19% of the users reported dual contraceptive use. About 58% got family planning from antiretroviral therapy clinics. Almost all the women (97.6%) had heard of seven modern family planning methods. Desire to have another child was the most common (79.7%) reason for not using family planning. Women who attended primary/secondary education (adjusted odds ratio: 2.61; 95% confidence interval: 1.29-5.28], who had no future fertility desire (adjusted odds ratio: 2.94; 95% confidence interval: 1.51-5.73), who had discussed family planning with their husband (adjusted odds ratio: 2.06; 95% confidence interval: 1.04-4.10), and who were counseled by the antiretroviral therapy provider about family planning (adjusted odds ratio: 4.53; 95% confidence interval: 1.70-12.06) were more likely to use family planning methods than their counterparts. Conclusion: The results of this study revealed that the use of modern family planning was low. There is a high frequency of implant usage, fear of mother-to-child transmission as a motivator for family planning usage, and low dual method usage. Hence, improving women's education, involving husbands, and consistent family planning counseling by antiretroviral therapy providers are promising strategies to improve the uptake of modern family planning by women living with HIV.
BMC Women's Health, 2015
Background: Eliminating family planning (FP) unmet need among HIV-infected individuals (PLHIV) is critical to elimination of mother-to-child HIV transmission. We assessed FP unmet need among PLHIV attending two clinics with differing models of FP services. Nsambya Home Care provided only FP information while Mulago HIV clinic provided information and contraceptives onsite. Methods: In a cross-sectional study conducted between February-June 2011, we documented pregnancies, fertility desires, and contraceptive use among 797 HIV-infected men and women (408 in Mulago and 389 in Nsambya). FP unmet need was calculated among women who were married, unmarried but had sex within the past month, did not desire the last or future pregnancy at all or wished to postpone for ≥ two years and were not using contraceptives. Multivariable analyses for correlates of FP unmet need were computed for each clinic.
BMC Pregnancy and Childbirth, 2013
Background: In settings where sexually transmitted infection (STI) and HIV prevalence is high, the postpartum period is a time of increased biological susceptibility to pregnancy related sepsis. Enabling women living with HIV to avoid unintended pregnancies during the postpartum period can reduce vertical transmission and maternal mortality associated with HIV infection. We describe family planning (FP) practices and fertility desires of HIV-positive and HIV-negative postpartum women in Swaziland. Methods: Data are drawn from a baseline survey of a four-year multi country prospective cohort study under the Integra Initiative, which is measuring the benefits and costs of providing integrated HIV and sexual and reproductive health (SRH) services in Kenya and Swaziland. We compare data from 386 HIV-positive women and 483 HIV-negative women recruited in Swaziland between February and August 2010. Data was collected on hand-held personal digital assistants (PDAs) covering fertility desires, mistimed or unwanted pregnancies and contraceptive use prior to their most recent pregnancy. Data were analysed using Stata 10.0. Descriptive statistics were conducted using the chi square test for categorical variables. Measures of effect were assessed using multivariate fixed effects logistic regression model accounting for clustering at facility level and the results are presented as adjusted odds ratios. Results: Majority (69.2%) of postpartum women reported that their most recent pregnancy was unintended with no differences between HIV-positive and HIV-negative women: OR: 0.96 (95% CI) (0.70, 1.32). Although, there were significant differences between HIV-positive and HIV-negative women who reported that their previous pregnancy was unwanted, (20.7% vs. 13.5%, p = 0.004), when adjusted this was not significant OR: 1.43 (0.92, 1.91). 47.2% of HIV-positive women said it was mistimed compared to 52.5%, OR: 0.79 (0.59, 1.06). 37.9% of all women said they do not want another child. Younger women were more likely to have unwanted pregnancies: OR: 1.12 (1.07, 1.12), while they were less likely to have mistimed births; OR: 0.82 (0.70, 0.97). Those with tertiary education were less likely to have unwanted or mistimed pregnancies OR: 0.30 (0.11, 0.86). Half of HIV-positive women and more than a third of HIV-negative women reported that they had been using a FP method when they became pregnant with no differences between the groups: OR: 1.61 (0.82,3.41). Only short-acting methods were available to these women before the most recent pregnancy; and available during the postpartum visit. One fifth of all women received an FP method during the current visit. Among the four fifths who did not receive a method 17.3% reported they were already using a method or were breastfeeding. HIV-positive women were more likely to have already started a method than HIV-negative women (20% vs. 15%, p = 0.089).