Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011

  • B. Maraux
    Corresponding author. CESP INSERM, Hôpital Paul Brousse, 16 Avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France. Tel.: +33-6-77-80-30-14; fax: +33-1-77-74-74-03.
    INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France
    Search for articles by this author
  • C. Hamelin
    INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France

    Université de Versailles Saint-Quentin en Yvelines, Villejuif, France
    Search for articles by this author
  • N. Bajos
    INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France

    INED, Paris, France

    Université Paris Sud, Le Kremlin-Bicêtre, France
    Search for articles by this author
  • R. Dray-Spira
    INSERM, UMRS 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France

    Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
    Search for articles by this author
  • B. Spire
    INSERM UMRS 912 (SESSTIM), Marseille, France

    Aix Marseille Université, UMRS 912, IRD, Marseille, France

    ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-D'azur, Marseille, France
    Search for articles by this author
  • F. Lert
    INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France

    Université de Versailles Saint-Quentin en Yvelines, Villejuif, France
    Search for articles by this author
  • and theVespa2 study group



      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • WHO
        Guidelines on care, treatment and support for women living with HIV and their children in resource-constrained settings.
        2006 ([])
        • O'Reilly K.R.
        • Kennedy C.E.
        • Fonner V.A.
        • Sweat M.D.
        Family planning counseling for women living with HIV: a systematic review of the evidence of effectiveness on contraceptive uptake and pregnancy incidence, 1990 to 2011.
        BMC Public Health. 2013; 13: 935
        • Robinson J.A.
        • Jamshidi R.
        • Burke A.E.
        Contraception for the HIV-positive woman: a review of interactions between hormonal contraception and antiretroviral therapy.
        Infect Dis Obstet Gynecol. 2012; 2012: 890160
        • WHO
        Hormonal contraception and HIV, technical statement.
        • Curtis K.M.
        • Nanda K.
        • Kapp N.
        Safety of hormonal and intrauterine methods of contraception for women with HIV/AIDS: a systematic review.
        AIDS. 2009; 23: S55-S67
        • Haberl A.
        • Reitter A.
        How does HIV affect the reproductive choices of women of childbearing age?.
        Antivir Ther. 2013; 18: 35-44
        • Sutton M.Y.
        • Patel R.
        • Frazier E.L.
        Unplanned pregnancies among HIV-infected women in care — United States.
        J Acquir Immune Defic Syndr. 2014; 65: 350-358
        • Lopez L.M.
        • Steiner M.
        • Grimes D.A.
        • Hilgenberg D.
        • Schulz K.F.
        Strategies for communicating contraceptive effectiveness.
        Cochrane Database Syst Rev. 2013; 4: CD006964
        • Cicconi P.
        • Monforte Ad
        • Castagna A.
        • Quirino T.
        • Alessandrini A.
        • Ammassari A.
        • et al.
        Inconsistent condom use among HIV-positive women in the “Treatment as Prevention Era”: data from the Italian DIDI study.
        J Int AIDS Soc. 2013; 16: 18591
        • Massad L.S.
        • Evans C.T.
        • Wilson T.E.
        • Golub E.T.
        • Sanchez-Keeland L.
        • Minkoff H.
        • et al.
        Contraceptive use among U.S. women with HIV.
        J Womens Health. 2007; 16: 657-666
        • Fiore Simona
        • Heard Isabelle
        • Thorne Claire
        • Savasi Valeria
        • Coll Oriol
        • Malyuta Ruslan
        • et al.
        Reproductive experience of HIV-infected women living in Europe.
        Hum Reprod. 2008; 23: 2140-2144
        • Nostlinger C.
        • Niderost S.
        • Woo R.
        • Platteau T.
        • Loos J.
        • Colebunders R.
        Mirror, mirror on the wall: the face of HIV+ women in Europe today.
        AIDS Care. 2010; 22: 919-926
        • Loutfy M.R.
        • Sonnenberg-Schwan U.
        • Margolese S.
        • Sherr L.
        A review of reproductive health research, guidelines and related gaps for women living with HIV.
        AIDS Care. 2013; 25: 657-666
        • Poncet L.C.
        • Huang N.
        • Rei W.
        • Lin Y.-C.
        • Chen C.-Y.
        Contraceptive use and method among immigrant women in France: relationship with socioeconomic status.
        Eur J Contracept Reprod Health Care. 2013; 18: 468-479
        • Bajos N.
        Contraception in France: new context, new practices?.
        Popul Soc. 2012; 492: 1-4
        • Wilson K.D.
        • Dray-Spira R.
        • Aubrière C.
        • Hamelin C.
        • Spire B.
        • Lert F.
        • et al.
        Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group — results from the ANRS-VESPA2 Study, France.
        AIDS Care. 2014; : 1-11
        • WHO Family Planning
        • Moreau C.
        • Bouyer J.
        • Bajos N.
        • Rodríguez G.
        • Trussell J.
        • et al.
        Frequency of discontinuation of contraceptive use: results form French population-based cohort.
        Hum Reprod. 2007; 22 ([Epub 2007 Jun 28]): 2422-2427
        • EU-SILC (European Union Statistics on Income and Living Conditions)
        Eurostat methodological studies and publications.
      1. Global Report.
        UNAIDS, 2014 ([])
        • WHO
        Medical eligibility criteria for contraceptive use.
      2. French experts' recommendations for the management of people living with HIV/AIDS.
      3. UN World Contraceptive Use.
        • Heard I.
        • Potard V.
        • Costagliola D.
        • Kazatchkine M.D.
        Contraceptive use in HIV-positive women.
        J Acquir Immune Defic Syndr. 2004; 36: 714-720
        • Kancheva Landolt N.T.
        • Lakhonphon S.
        • Ananworanich J.
        Contraception in HIV-positive female adolescents.
        AIDS Res Ther. 2011; 8: 19
        • Sun M.
        • Peipert J.F.
        • Zhao Q.
        • Wilson T.E.
        • Weber K.M.
        • Sanchez-Keeland L.
        • et al.
        Trends in contraceptive use among women with human immunodeficiency virus.
        Obstet Gynecol. 2012; 120: 783-790
        • Saxton J.
        • Malyuta R.
        • Semenenko I.
        • Pilipenko T.
        • Tereshenko R.
        • Kulakovskaya E.
        • et al.
        Previous reproductive history and post-natal family planning among HIV-infected women in Ukraine.
        Hum Reprod. 2010; 25: 2366-2373
        • Whiteman M.K.
        • Kissin D.M.
        • Samarina A.
        • Curtis K.M.
        • Akatova N.
        • Marchbanks P.A.
        • et al.
        Determinants of contraceptive choice among women with HIV.
        AIDS. 2009; 23: S47-S54
        • Carten M.L.
        • Kiser J.J.
        • Kwara A.
        • Mawhinney S.
        • Cu-Uvin S.
        Pharmacokinetic interactions between the hormonal emergency contraception, levonorgestrel (Plan B), and Efavirenz.
        Infect Dis Obstet Gynecol. 2012; 2012: 137192
        • EPF Survey (French Perinatal Cohort)
        INSERM, INED U569.
        • Peretti-Watel P.
        • Spire B.
        SIDA, une maladie chronique passée au crible.
        Presses EHESP, 2008
        • Steiner R.J.
        • Finocchario-Kessler S.
        • Dariotis J.K.
        Engaging HIV Care providers in conversations with their reproductive-age patients about fertility desires and intentions: a historical review of the HIV epidemic in the United States.
        Am J Public Health. 2013; 103: 1357-1366
        • Bajos N.
        • Marquet J.
        Research on HIV sexual risk: social relations-based approach in a cross-cultural perspective.
        Soc Sci Med. 2000; 50: 1533-1546
        • Kendall T.
        Falling short of universal access to reproductive health: unintended pregnancy and contraceptive use among Mexican women with HIV.
        Cult Health Sex. 2013; 15: S166-S179
        • Fakoya A.
        • Lamba H.
        • Mackie N.
        • Nandwani R.
        • Brown A.
        • Bernard E.
        • et al.
        British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008.
        HIV Med. 2008; 9: 681-720
        • Moses S.H.
        • Dhar J.
        A survey of the sexual and reproductive health of HIV-positive women in Leicester.
        Int J STD AIDS. 2012; 23: 282-284
        • Finocchario-Kessler S.
        • Dariotis J.K.
        • Sweat M.D.
        • Trent M.E.
        • Keller J.M.
        • Hafeez Q.
        • et al.
        Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring?.
        AIDS Patient Care STDS. 2010; 24: 317-323
      4. Collectif interassociatif Women and HIV.
        Prevention issues: still involved? Collectif interassociatif Women and HIV, Paris2012
        • Bajos N.
        • Rouzaud-Cornabas M.
        • Panjo H.
        • Bohet A.
        • Moreau C.
        • the FECOND group
        The French pill scare: towards a new contraceptive model?.
        Popul Soc. 2014; ([])