With increased availability of antiretroviral therapy and improved survival for people living with HIV, more HIV-positive women are leading full reproductive lives. However, HIV-positive women have special contraceptive needs/concerns. This paper examines the individual and community-level HIV/AIDS factors associated with contraceptive use and compares predictors of contraceptive uptake between HIV-positive and HIV-negative women in Kenya.
The study is based on secondary analysis of cross-sectional data of a sample of 9132 sexually active women of reproductive age from the Kenya Demographic and Health Surveys collected in 2003 and 2008. Multilevel logistic regression models are used to examine individual and contextual community-level factors associated with current contraceptive use.
The study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities. It further reveals striking differences in factors associated with contraceptive uptake between HIV-positive and HIV-negative women. Education and the desire to stop childbearing are strongly associated with contraceptive uptake among uninfected women, but both factors are not significant among HIV-positive women for whom wealth is the most important factor. While HIV-negative women in the richest wealth quintile are about twice as likely to use contraceptives as their counterparts of similar characteristics in the poorest quintile, this gap is about sevenfold among HIV-positive women.
These findings suggest that having the desire and relevant knowledge to use contraceptives does not necessarily translate into expected contraceptive behavior for HIV-positive women in Kenya and that poor HIV-positive women may be particularly in need of increased access to contraceptive services.
• Study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities in Kenya.
• Results reveal striking differences in factors associated with contraceptive use between HIV-positive and HIV-negative women.
• Poverty may be an impediment to contraceptive uptake among HIV-positive women in Kenya.
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- ‘Life is still going on’: reproductive intentions among HIV-positive women and men in South Africa.Soc Sci Med. 2007; 65: 274-283
- Reproductive choice for women and men living with HIV: contraception, abortion and fertility.Reprod Health Matters. 2007; 15: 46-66
- Behavioral interventions for improving contraceptive use among women living with HIV.Cochrane Database Syst Rev. 2013; CD010243https://doi.org/10.1002/14651858.CD010243.pub2
- The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women.J Acquir Immune Defic Syndr. 2008; 47: 477-483
- Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission.J Biosoc Sci. 2009; 41: 269-278
- Fertility preferences and the need for contraception among women living with HIV: the basis for a joint action agenda.AIDS Behav. 2009; 23: S7-S17
- Factors associated with conception among a sample of HIV-positive women at a hospital in Uganda.Afr J AIDS Res. 2009; 8: 255-260
- Factors associated with repeat pregnancy among women in an area of high HIV prevalence in Zimbabwe.Womens Health Issues. 2011; 21: 222-229
- High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa.PLoS One. 2012; 7https://doi.org/10.1371/journl.pone.0036039
- The effects of unintended pregnancy on infant, child, and parental health: a review of the literature.Stud Fam Plan. 2008; 39: 18-38
- Maternal health and HIV.Reprod Health Matters. 2005; 13: 129-135
- Risk factors for very preterm delivery and delivery of very-small-for-gestational age infants among HIV-exposed and HIV-unexposed infants in Botswana.Int J Gynecol Obstet. 2011; 115: 20-25
- Reproductive behaviour among women on antiretroviral therapy in Botswana: mismatched pregnancy plans and contraceptive use.Afr J AIDS Res. 2014; 13: 305-311
- Pregnancy decisions among HIV-positive pregnant women in Mulago hospital, Uganda.Cult Health Sex. 2010; 12: 445-454
- Women's and men's fertility preferences and contraceptive behaviors by HIV status in 10 sub-Saharan African countries.AIDS Educ Prev. 2011; 23: 313-328
- Effect of HIV status on fertility intention and contraceptive use among women in nine sub-Saharan African countries: evidence from demographic and health surveys.Glob Health Action. 2014; 23: 255-279
- Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda.AIDS Behav. 2006; 10: S95-104
- Missed opportunities to address reproductive health care needs among HIV-infected women in antiretroviral therapy programmes.Tropical Med Int Health. 2007; 12: 1484-1489
- Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study.PLoS One. 2009; 4e4149
- ‘Pregnancy comes accidentally – like it did with me’: reproductive decisions among women on ART and their partners in rural Uganda.BMC Public Health. 2011; https://doi.org/10.1186/1471-2458-11-530
- Uncertainty and fertility in a generalized AIDS epidemic.Am Sociol Rev. 2011; 76: 935-954
- Now or never: perceived HIV status and fertility intentions in rural Mozambique.Stud Fam Plan. 2012; 43: 191-199
- Kenya demographic and health survey 2003.CBS, MOH, and ORC Macro, Calverton, Maryland2004
- Investigating the association between HIV/AIDS and recent fertility patterns in Kenya.Soc Sci Med. 2010; 71: 335-344
- Social conditions as fundamental causes of disease.J Health Soc Behav. 1995; 35: 80-94
- Rethinking conceptual approaches to behaviour change: the importance of context.Centre for AIDS Development, Research and Evaluation (CADRE), 2004: 3-11
- HIV prevalence estimates from the demographic and health surveys.ICF Macro, Calverton, MD2010
- Kenya demographic and health survey 2008-09.KNBS and ICF Macro, Calverton, Maryland2010
- Trends and determinants of contraceptive method choice in Kenya.Stud Fam Plan. 2003; 34: 149-159
- A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: evidence from the DHS.Health Place. 2011; 17: 1067-1083
- Dagitty: a graphical tool for analyzing causal diagrams.Epidemiology. 2011; 22: 745
- Multilevel statistical models.3rd ed. Arnold, London2003
- A users guide to MLwiN, version 2.32.Centre for Multilevel Modelling, University of Bristol, UK2015
- Evaluating the impact of non-response on the KDHS HIV prevalence estimates.([Calverton, Maryland, USA])2004
Published online: November 08, 2016
Accepted: October 31, 2016
Received in revised form: October 28, 2016
Received: February 16, 2016
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