Abstract
Despite improved availability of simple, relatively inexpensive, and highly effective antiretroviral treatment for HIV/AIDS, the disease remains a major public health challenge for women in sub-Saharan Africa (SSA). Given the numerous barriers in access to care for women in this region, every health issue that brings them into contact with the health system should be optimized as an opportunity to integrate HIV/AIDS prevention. Because most non-condom forms of modern contraception require a clinical appointment for use, contraception appointments could provide a confidential opportunity for access to HIV counseling, testing, and referral to care. This study sought to investigate the relationship between contraceptive methods and HIV testing among women in SSA. Data from the Demographic and Health Survey from four African countries—Congo, Mozambique, Nigeria, and Uganda—was used to examine whether modern (e.g., pills, condom) or traditional (e.g., periodic abstinence, withdrawal) forms of contraception were associated with uptake of HIV testing. Data for the current analyses were restricted to 35,748 women with complete information on the variables of interest. Chi-square tests and logistic regression models were used to assess the relationship between uptake of HIV testing and respondents' baseline characteristics and contraceptive methods. In the total sample and in Mozambique, women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception. This positive association was not demonstrated in Congo, Nigeria, or Uganda. That many women who access modern contraception are not tested for HIV in high HIV burden areas highlights a missed opportunity to deliver an important intervention to promote maternal and child health. Given the increasing popularity of hormonal contraception methods in low-income countries, there is an urgent need to integrate HIV counseling, testing, and treatment into family planning programs. Women on hormonal contraceptives should be encouraged to continue to use condoms for HIV-prevention.
Highlights
In 2013, 35 million people worldwide were living with HIV, of which 2.1 million had become newly infected [1]
In the total sample and in Mozambique, women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception
Women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception
Summary
In 2013, 35 million people worldwide were living with HIV, of which 2.1 million had become newly infected [1]. Women in SSA are disproportionately infected with HIV via heterosexual contact during their reproductive years [2]. Abstinence and condom use are two of the three endorsed behavioral strategies recommended by HIV prevention programs, emphasizing the ABC approach to HIV reduction—i.e. abstinence, be faithful, and condom use programs. There is little doubt that condom use and abstinence provide proven prevention options in reducing HIV transmission [3,4]; it has become increasingly apparent that the ABC approach over simplifies the complex nature of the HIV epidemic [5,6,7]
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