According to data published in PLoS One, effective contraception, condoms, and dual contraceptive method use were inadequate in a cohort of young HIV-positive women, highlighting a need for individual-level interventions.
From November 2013 to August 2015, this cross-sectional study enrolled 103 women, age 14 to 30 years, who were infected with HIV perinatally and horizontally, and who were recruited from the Grady Infectious Disease Clinic in Atlanta, Georgia. The average age of participants was 22.1 years, 74 participants reported a history of sexual activity, 89% were African American, 52% were perinatally infected, 89% received combination antiretroviral therapy, and 63% had undetectable viral loads. At the time of most recent coitus, 46% of participants reported either most or moderately effective contraception, 62% reported condom use, and 27% reported dual method use.
The odds of most or moderately effective contraception use was significantly reduced in those with detectable viral loads vs undetectable viral loads (adjusted odds ratio [aOR] .13; 95% CI, .04-.38). Factors associated significantly with reduced condom use were older age (aOR .85; 95% CI, .74-.98) and higher frequency of coitus (more than once/week vs less than once/week; aOR .24; 95% CI, .08-.72). Having a detectable viral load (aOR .13; 95% CI,.03-.69) and more frequent coitus (aOR .14; 95% CI, .03-.82) were associated with reduced dual method use, whereas increased dual method use was associated with school enrollment (aOR 5.63; 95% CI, 1.53-20.71).
This study evaluated a broad range of potential influences; however, this may contribute to increased risk for type I errors. The study was also limited by a small sample size, which reduced the power to detect potential associations that may exist and to conduct a multinomial logistic regression evaluating distinct categorical differences among those who use condoms only, contraceptives only, or dual method use. Further, because the data are cross-sectional, no comments on causality or temporality can be made. In addition, relying on self-reporting may have increased the chances of recall and social desirability bias, and the cohort may not be representative of areas beyond metropolitan Atlanta.
Investigators concluded that there is a need to “enhance individual-level interventions to improve pregnancy and STI/HIV prevention practices among young HIV-infected women in the United States.”
Haddad LB, Brown JL, King C, et al. Contraceptive, condom and dual method use at last coitus among perinatally and horizontally HIV-infected young women in Atlanta, Georgia. PLos One. 2018;13:e0202946