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. (2nd April 2014)

• Record Type: Journal Article
• Authors: Church, Kathryn; Wringe, Alison; Fakudze, Phelele; Kikuvi, Joshua; Nhlabatsi, Zelda; Masuku, Rachel; Initiative, Integra; Mayhew, Susannah H
• Other Names: Abuya Timothy author non-byline.; Askew Ian author non-byline.; Birdthistle Isolde author non-byline.; Church Kathryn author non-byline.; Colombini Manuela author non-byline.; du-Preez Natalie Friend author non-byline.; Kikuvi Joshua author non-byline.; Kimani James author non-byline.; Kivunaga Jackline author non-byline.; Mak Joelle author non-byline.; Mayhew Susannah author non-byline.; Michaels Christine author non-byline.; Mutemwa Richard author non-byline.; Ndigwa Charity author non-byline.; Obure Carol Dayo author non-byline.; Sweeney Sedona author non-byline.; Vassall Anna author non-byline.; Warren Charlotte author non-byline.; Watts Charlotte author non-byline.; Zhou Weiwei author non-byline.
• Is Part Of: Sexually transmitted infections. Volume 90:issue 5(2014)
• Page Start: 394
• Page End: 400
• Publication Date: 2014-04-02
• Subjects: AFRICA -- CONTRACEPTION -- CONDOMS -- FAMILY PLANNING -- HIV CLINICAL CARE; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2013-051339
• Languages: English
• ISSNs: 1368-4973

Abstract

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. 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. 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. 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.