Contraceptive use by couples when one partner is infected with HIV

Abstract

Objectives For HIV-positive people who are sexually active, correct and consistent use of condoms is the most effective way to prevent transmission of HIV infection to HIV-negative partners. [1,2] For most of those who are sexually active with opposite sex partners, pregnancy prevention is also a relevant goal. The best way to protect simultaneously against pregnancy and STD/HIV infection is the concurrent use of an effective barrier method such as condoms with an effective pregnancy prevention method. However, many people choose one or the other, so that use of an effective pregnancy prevention method may discourage use of a barrier method, and vice versa. [3,4] Use of contraceptive methods in HIV-infected populations has been little studied. Interviews with 1,232 sexually active HIV-infected women ages 18-50 showed that 47% had used condoms as a form of contraception in the last 12 months, with lower use among women who had tubal ligations or used oral contraceptives.[5] The objectives of this study were (1) to ascertain the prevalence of use of specific contraceptive methods among heterosexual couples in the U.S. when at least one partner is infected with HIV, and (2) to identify demographic and attitudinal factors predicting condom use in this population. Methods Data are from the Risk and Prevention (R&P) Study of the HIV Cost and Services Utilization Study (HCSUS) cohort, a probability sample of HIV-positive adults who had at least one visit for health care at a facility other than a military, prison, or emergency department facility during a 2-month period in early 1996 in the 48 contiguous states of the U.S. The R&P Study, conducted in the fall of 1998, included a stratified random sample of 1,794 of the 2,267 individuals who completed a second HCSUS follow-up interview (August 1997-January 1998), excluding non-English speakers and those of unknown gender. Interviews were obtained with 1,421 individuals, for a response rate of 84%. Analysis of contraceptive use focused on R&P participants for whom pregnancy prevention was a potential concern: 292 women aged 20 to 50 years and 177 men aged 20 years or more who had sex with one or more opposite sex partners in the last 6 months. Results were weighted to adjust for differential probabilities of selection and for attrition. All respondents who were heterosexually active in the last six months were asked a series of questions: 'In the last 6 months, have you or a partner used (method)?' For each method used, follow-up questions asked whether the method was used to prevent pregnancy, was used for other reasons, and was used concurrently with condoms. Results The population was heavily minority (53% African American, 17% Hispanic, 29% white), and 26% of women and 51% of men had been infected through injection drug use. Over 80% were either married or in a heterosexual relationship. Many had advanced HIV disease (49% of women and 61% of men had a lowest-ever CD4 cell count <200 cells/mm3). Eighty one percent of women and 89% of men reported using at least one contraceptive method in the last 6 months. Seventy-eight percent of women and 87% of men used condoms, including 35% of women and 47% of men to prevent pregnancy. Thirty-five percent of women reported having a tubal ligation, and 15% of men reported that a partner had had one. Eleven percent of women reported using oral contraceptives, and 5% of men had a partner who used them. Other effective methods of pregnancy prevention received little use. Three percent of women and 6% of men reported use of microbicides. Among women, demographic characteristics positively associated with condom use included being Hispanic, having some college education, being partnered but not married, and having a spouse or partner who was HIV-negative. Attitudes predicting condom use for women included perceived norms supporting condom use, perceived efficacy of condoms, perceived responsibility to limit HIV transmission, and low optimism about HIV treatment. Among men, having some college education was associated with condom use, but other demographic characteristics and attitudes were not significantly related. Conclusions Use of condoms in this population is highly prevalent, and is nearly universal among those using any contraceptive method. Among those not using condoms, HIV transmission risk depends on the HIV status of partners. Except for tubal ligation, the most effective methods of pregnancy prevention (e.g., oral contraceptives, intrauterine devices) are not widely used, even by those who do not desire children. Thus, counseling and other interventions to help HIV+ people prevent both HIV transmission and pregnancy may be of value.