Abstract
Objectives
Mobility (international/internal migration, and localized mobility) is a key driver
of the HIV epidemic. While mobility is associated with higher-risk sexual behavior
in women, a possible association with condom, modern contraceptive, and dual method
use among women living with HIV (WLHIV), is unknown. In addition, HIV status and sexual
behaviors such as relationship concurrency may also affect condom, modern contraceptive,
and dual method use.
Study design
We surveyed sexually active women (N = 1067) aged 15 to 49 in 12 communities in Kenya
and Uganda participating in a test-and-treat trial in 2015 to 2016. Generalized (unordered)
multinomial logistic regression models accounting for community clustering examined
associations between mobility (overnight travel away from home in past 6 months and
any migration within past 2 years) and condom, modern contraceptive (i.e., oral contraceptive
pills, injectables, intrauterine devices, implants, vasectomy, tubal ligation; excluding
male/female condoms), and dual method use within past 6 months, adjusting for key
covariates such as HIV status and relationship concurrency.
Results
WLHIV relative to HIV-negative women (ratios of relative risk [RRR] = 3.76, 95% confidence
interval [CI]: 2.40–5.89), and women in concurrent relative to monogamous relationships
(RRR = 4.03, 95% CI 1.9–8.50) had higher odds of condom use alone. In contraceptive
use models, WLHIV relative to HIV-negative women were less likely to use modern contraceptive
methods alone (RRR = 0.51, 95% CI 0.36–0.73). Relationship concurrency (RRR = 4.51,
95% CI 2.10–9.67) and HIV status (RRR = 3.97, 95% CI 2.43–6.50) were associated with
higher odds of dual method use while mobility was marginally associated with higher
odds of dual method use (RRR = 1.65, 95% CI 0.99–2.77, p = 0.057).
Conclusions
Mobility had a potential impact on dual method use in Kenya and Uganda. In addition,
our findings highlight that WLHIV were using condoms and dual methods more, but modern
contraceptives less, than HIV-negative women. Those in concurrent relationships were
also more likely to use condoms or dual methods. These findings suggest that in a
context of high mobility, women may be appropriately assessing risks and taking measures
to protect themselves and their partners from unintended pregnancies and acquisition
and transmission of HIV.
Implications
Our findings point to a need to strengthen accessibility of sexual and reproductive
health services for both mobile and residentially stable women in settings of high
mobility and high HIV prevalence.
Keywords
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Article info
Publication history
Published online: September 13, 2022
Accepted:
September 7,
2022
Received in revised form:
September 7,
2022
Received:
December 8,
2021
Footnotes
Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
Funding: This study was supported by grants from the National Institutes of Health, NIMH under award number R01MH104132 (Camlin, Mobility in SEARCH), and the NIAID under award number U01AI099959 (Havlir, SEARCH). SAG was supported by the National Institutes of Mental Health of the U.S. Public Health Service under grant T32 MH19105.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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© 2022 Published by Elsevier Inc.
