Reliance on condoms for contraceptive protection among HIV care and treatment clients: a mixed methods study on contraceptive choice and motivation within a generalised epidemic.


Church, K; Wringe, A; Fakudze, P; Kikuvi, J; Nhlabatsi, Z; Masuku, R; Initiative Integra, ; Mayhew, SH; , COLLABORATORS; Abuya, T; Askew, I; Birdthistle, I; Church, K; Colombini, M; du-Preez, NF; Kikuvi, J; Kimani, J; Kivunaga, J; Mak, J; Mayhew, S; Michaels, C; Mutemwa, R; Ndigwa, C; Obure, CD; Sweeney, S; Vassall, A; Warren, C; Watts, C; Zhou, W; (2014) Reliance on condoms for contraceptive protection among HIV care and treatment clients: a mixed methods study on contraceptive choice and motivation within a generalised epidemic. Sexually transmitted infections, 90 (5). pp. 394-400. ISSN 1368-4973 DOI: https://doi.org/10.1136/sextrans-2013-051339

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Abstract

OBJECTIVES: To (i) describe the contraceptive practices of HIV care and treatment (HCTx) clients in Manzini, Swaziland, including their unmet needs for family planning (FP), and compare these with population-level estimates; and (ii) qualitatively explore the causal factors influencing contraceptive choice and use.<br/> METHODS: Mixed quantitative and qualitative methods were used. A cross-sectional survey conducted among HCTx clients (N=611) investigated FP and condom use patterns. Using descriptive statistics, findings were compared with population-level estimates derived from Swaziland Demographic and Health Survey data, weighted for clustering. In-depth interviews were conducted with HCTx providers (n=16) and clients (n=22) and analysed thematically.<br/> RESULTS: 64% of HCTx clients reported current contraceptive use; most relied on condoms alone, few practiced dual method use. Rates of condom use for FP among female HCTx clients (77%, 95% CI 71% to 82%) were higher than population-level estimates in the study region (50% HIV-positive, 95% CI 43% to 57%; 37% HIV-negative, 95% CI 31% to 43%); rates of unmet FP needs were similar when condom use consistency was accounted for (32% HCTx, 95% CI 26% to 37%; vs 35% HIV-positive, 95% CI 28% to 43%; 29% HIV-negative, 95% CI 24% to 35%). Qualitative analysis identified motivational factors influencing FP choice: fears of reinfection; a programmatic focus on condoms for people living with HIV; changing sexual behaviours before and after antiretroviral therapy (ART) initiation; failure to disclose to partners; and contraceptive side effect fears.<br/> CONCLUSIONS: Fears of reinfection prevailed over consideration of pregnancy risk. Given current evidence on reinfection, HCTx services must move beyond a narrow focus on condom promotion, particularly for those in seroconcordant relationships, and consider diverse strategies to meet reproductive needs.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Population Studies Group
Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 24695990
Web of Science ID: 339281500013
URI: http://researchonline.lshtm.ac.uk/id/eprint/1635678

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