Abstract
Objectives
Advances in antiretroviral treatment (ART) have led to improvements in reproductive
health for women living with HIV. This paper aims to investigate the pattern of contraceptive
use among women living with HIV in France.
Study design
Data were drawn from the ANRS VESPA2 study, which included a representative sample
of HIV-positive people. Contraception methods were documented, including condoms,
highly effective contraception methods (HEC) and traditional methods.
We measured the frequency of not using any modern contraception (neither condoms nor
HEC) and of HEC use and studied their correlates (i.e., geographic origin, age, parity,
partnership status, education level, material deprivation, employment status, health
insurance, visits to a gynecologist, being on ART, cardiovascular risk) among women
at risk of an unintended pregnancy.
Results
Of the 662 women of reproductive age, 327 were in need of contraception. Overall,
20.5% used HEC, 58.8% used condoms and 20.7% used traditional or no methods, with
no difference according to geographic origin [sub-Saharan African (SSA) women vs.
French and other migrant women]. Among SSA women, being <30 years old [odds ratio (OR) 16.39, 95% confidence interval (95%CI) 2.77–97.01], having
had at least one child (OR 3.75, 95%CI 1.75–8.04) and being employed (OR 2.36, 95%CI
0.99–5.61) were associated with HEC use; among French and other migrant women, HEC
use was associated with being in a stable partnership (OR 4.5, 95%CI 1.2–17.2) and
material deprivation (OR 3.3 95%CI 1.4–9.8). Gynecologist visits, health insurance
status and cardiovascular risk were not associated with HEC use.
Conclusions
Condoms remained the predominant contraceptive method despite the absence of restrictions
on hormonal contraception and intrauterine device use for HIV-positive women. The
recent recommendations about dual method protection should be actively promoted, targeting
HIV-positive women, HIV specialists and gynecologists to overcome the barriers to
effective contraception.
Implications
The information provided in this study constitutes a major contribution to comprehensively
inform the scientific community on contraception practices among women living with
HIV in France in the early 2010s. Our results show that the therapeutic advances since
the late 1990s and the removal of restrictions on hormonal contraception use have
not led to the expected shift in contraception patterns. There is an urgent need to
promote dual method protection, as condom use may decrease in the future in the context
of the preventive effect of ART.
Keywords
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Article info
Publication history
Published online: May 01, 2015
Accepted:
April 28,
2015
Received in revised form:
April 24,
2015
Received:
June 26,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
