Factors Relating to Contraceptive Method Use in HIV-Positive Women

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A large percentage of predominantly African American HIV-positive women in an urban, outpatient setting had misconceptions about contraception.
A large percentage of predominantly African American HIV-positive women in an urban, outpatient setting had misconceptions about contraception.

A large percentage of predominantly African American HIV-positive women in an urban, outpatient setting had misconceptions about contraception but were more likely to use higher-efficacy forms of contraception than the general African American population, and younger women were more likely to use more effective contraceptive methods than older women, according to a study published in Contraception.

The current study sought to evaluate factors associated with the methods of contraception used by HIV-positive women, age 18 to 45, who were recruited from the patient population at an outpatient clinic in Atlanta, Georgia, from 2013 to 2014. These women completed a survey to identify characteristics of clinical, demographic, and reproductive health surrounding contraception. Using multivariate logistic regression and chi-square tests, investigators examined the associations between survey responses and use of contraceptive methods at last coitus.

Methods defined as more effective (implants, injectable Depot medroxyprogesterone acetate, IUDs, and combined hormonal rings, patches, or pills) were termed Tier 1 and 2, and less effective methods were termed Tier 3 or No method (condom alone, withdrawal, and no contraception), according to the U.S. Medical Eligibility Criteria for contraception use. It was not possible to analyze individual methods of contraception due to the low utilization of Tier 1 methods.

Of the 136 eligible HIV-positive women who completed the survey, 90% were found to be African American, 31% reported using Tier 1 and 2 methods of contraception, and 21% reporting using dual contraceptive methods at last coitus. Tier 1 and 2 method use was more prevalent among younger participants (adjusted odds ratio [aOR], 0.90; P =.008), and participants in uncommitted relationships (aOR, 0.32; P =.027).

In all, 25% of the cohort reported having never used any form of contraception. Among contraception users, more than 2/3 responded that when choosing birth control, they rated the following as very important: the method's effectiveness of preventing HIV/STI transmission, effectiveness of pregnancy prevention, and feeling in control of their choice to use the method.

Of the total cohort, 31% reported having heard of contraceptive implants, and 53% reported having heard of IUDs. Misconceptions about contraception—such as all hormonal contraceptive methods cause weight gain (believed by 63%), IUDs can move around in the body (28%), and believing that long-acting methods of contraception could not be removed early when a woman decides to become pregnant (36%)—were prevalent. The general knowledge level concerning contraception was similar between Tier 1, 2, 3, and No method respondents.

Study investigators conclude that “providers should address real and perceived barriers to T1/2 methods, breadth of method options while placing emphasis on pregnancy intention and desire, patient preferences, and the importance of dual use with HIV-positive women.” 

This work was supported by the Society of Family Planning.

Reference

Tote KM, Raziano VT, Wall KM, Cordes S, Ofotokun I, Haddad LB. Contraceptive method use among HIV-positive women in a US urban outpatient clinic: An exploratory cross-sectional study [published online July 21, 2018]. Contraception. doi: 10.1016/j.contraception.2018.07.140

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