Abstract
Background
HIV-discordant heterosexual couples are faced with the dual challenge of preventing
sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal
HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive
(LARC) methods ��� intrauterine devices (IUD) and hormonal implants ��� among HIV-discordant
couples in Rwanda and Zambia.
Study Design
Women were interviewed alone or with their partner during routine cohort study follow-up
visits to ascertain fertility goals; those not pregnant, not infertile, not already
using LARC, and wishing to limit or delay fertility for ���3 years were counseled on LARC methods and offered an IUD or implant on-site.
Results
Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners),
365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant,
30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners),
528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant,
38 IUD). In both countries, a woman's younger age was predictive of LARC uptake. LARC
users reported fewer episodes of unprotected sex than couples using only condoms.
Conclusions
Integrated fertility goal-based family planning counseling and access to LARC methods
with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced
unprotected sex among HIV-discordant couples in two African capital cities.
Keywords
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Article info
Publication history
Published online: November 14, 2012
Accepted:
October 3,
2012
Received in revised form:
October 3,
2012
Received:
April 30,
2012
Footnotes
���Financial support: This work was supported by ongoing funding from the US National Institutes of Health (RO1: MH66767, HD40951), the AIDS International Training and Research Program (AITRP: FIC D43 TW001042), the Center for AIDS Research at Emory (P30 AI050409) and the International AIDS Vaccine Initiative. Funding was used for employment, travel and provision of writing assistance, surgical instruments, equipment and/or administrative support related to the study.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
