Awareness and Interest in Intrauterine Contraceptive Device Use among HIV-Positive Women in Cape Town, South Africa

Catherine S Todd,Hoviyeh Afnan-Holmes,Landon Myer,Linda-Gail Bekker,Tracy C Garber,Heidi E Jones,Helen Woolgar

doi:10.1155/2012/956145

Abstract

Objective. To assess awareness of and interest in intrauterine contraceptive device (IUCD) use among HIV-positive women in Cape Town, South Africa. Design. Cross-sectional survey. Methods. HIV-positive women aged 18 through 45 years presenting for care at a primary health care clinic in Cape Town, South Africa participated in this study. Consented participants completed a staff-administered questionnaire in a private setting. Descriptive statistics were generated. Comparisons between demographic and reproductive health-related variables and IUCD awareness and interest were performed with multiple logistic regression. Analyses for IUCD interest excluded women with prior surgical sterilization. Results. Of 277 HIV-positive women, 37% were aware of the IUCD; awareness was independently associated with greater age (adjusted odds ratio (AOR) = 1.15, 95%; confidence interval (CI): 1.10–1.20) and not switching contraceptive methods in the last year (AOR = 2.45, 95% CI: 1.03–5.83). Following an IUCD information session, 86% of women (n = 206/240) were interested in IUCD use. IUCD interest was inversely associated with age (AOR = 0.91, 95% CI: 0.86–0.97) and marginally positively associated with current menstrual bleeding pattern complaints (AOR = 2.14, 95% CI: 0.98–4.68). Conclusions. Despite low levels of method awareness, HIV-positive women in this setting are frequently interested in IUCD use, indicating need for programming to expand method access.

Highlights

Contraceptive use to prevent unplanned pregnancy is the most cost-effective means of preventing maternal-to-child transmission of HIV [1,2,3,4]
Some studies have suggested that systemic hormonal contraceptive method use by HIV-positive women may increase HIV transmission to male partners and progression of HIV disease among users, for depot medroxyprogesterone acetate (DMPA), though findings are mixed [8,9,10,11,12,13,14]
This study demonstrates low intrauterine contraceptive device (IUCD) awareness relative to other methods, injectable contraceptives, and high prevalence of IUCD interest among HIV-positive women

Summary

Introduction

Contraceptive use to prevent unplanned pregnancy is the most cost-effective means of preventing maternal-to-child transmission of HIV [1,2,3,4]. Some studies have suggested that systemic hormonal contraceptive method use by HIV-positive women may increase HIV transmission to male partners and progression of HIV disease among users, for depot medroxyprogesterone acetate (DMPA), though findings are mixed [8,9,10,11,12,13,14] These findings, coupled with high unmet need for contraception in Sub-Saharan Africa, have spurred calls for safe, long-acting reversible contraceptive methods for HIVpositive women [4, 15]. Two studies among reproductive aged women in South Africa indicate low (26–41%) awareness of the IUCD as a contraceptive method, despite its inclusion in contraceptive method mix and availability at no cost through the public sector [17, 18] Both studies found that a majority (69–74%) of women were interested in IUCD use after receipt of basic information about the method [17, 18].

Methods

Results

Conclusion