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High levels of unmet need for family planning in people with HIV - couples unaware of conception and contraception options
Roger Pebody, 2011-07-26 11:20:00
In Kenya, Tanzania and Namibia just 46% of HIV-positive women and 28% of HIV-positive men have discussed family planning with a health care provider, delegates were told at the International AIDS Society conference in Rome last week. In these and other African settings, few couples employ dual protection methods (using condoms alongside another contraceptive method), while there is low awareness of strategies which allow a serodiscordant to conceive while limiting the risk of sexual HIV transmission.
A number of posters quantified the unmet needs for contraception in various African countries, whilst studies from South Africa and Kenya explored men and women’s feelings about having a child, HIV transmission risk and interventions for safer conception. Treatment-as-prevention and pre-exposure prophylaxis were well accepted, whereas there was scepticism about sperm washing.
The largest quantitative study on unmet needs was conducted in 18 different clinics in Kenya, Tanzania and Namibia, recruiting 1992 women and 1483 men. Participants were living with HIV, sexually active and under the age of 50. The average (median) age of participants was 37, with an average of two children each.
Only a minority of participants reported that they had discussed family planning with a health care provider at their HIV clinic. The number who had done so varied from women to men, and from country to country. Overall 46% of women had had this discussion (68% in Kenya, 40% in Namibia and 32% in Tanzania). The number of men who had had family planning discussions was much lower, at 28% (41% in Kenya, 23% in Namibia and 21% in Tanzania).
Pregnancy was more often desired by men than women. Among men with HIV, 20% hoped for a pregnancy in the next six months, whereas among women with HIV, 14% did. Moreover 25% of women with HIV believed that their husband or main sexual partner wanted her to become pregnant.
Turning now to those individuals who were not hoping for a pregnancy in the coming months, only a minority were using dual protection, which is widely recommended. Dual protection combines condom use (protective against transmission of HIV and sexually transmitted infections) with another contraceptive method whose effectiveness is not reliant on it being used at the time of sex - for example pills, injections, implants and intrauterine devices.
Only 30% of women who didn’t want to get pregnant reported dual protection. In contrast, 12% used no method at all; 14% reported using a method such as pills or injections; and 44% reported only using condoms.
However there is such an emphasis on condoms in HIV services that there is a risk that participants exaggerated their use of condoms, in order to tell the researchers what they thought they wanted to hear. The investigators warn that if this is the case, the unmet family planning need is actually greater than they estimate.
Among the men not hoping to get their partner pregnant, 18% reported dual protection; 7% a method such as pills or injections; and 73% condom use only. Again, condom use may be over-reported.
There were variations between countries - for example, Tanzanians were the least likely to report having dual protection.
The researchers conclude that in this group of people with HIV wishing to delay or avoid pregnancy, seven out of ten women and eight out of ten men are not using dual protection and so have unmet family planning needs. It is likely that the limitations of the family planning information provided by health care workers is one cause of the low uptake of effective methods.
Source:1
