Abstract
BackgroundNorthern Uganda experienced severe civil conflict for over 20 years and is also a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region.MethodsBetween February and May 2009, a total of 476 HIV clinic attendees from three health facilities in Gulu, Northern Uganda, were interviewed using a structured questionnaire. Semi-structured interviews were conducted with another 26 participants. Factors associated with use of family planning methods were examined using logistic regression methods, while qualitative data was analyzed within a social-ecological framework using thematic analysis.ResultsThere was a high level of knowledge about family planning methods among the PLHIV surveyed (96%). However, there were a significantly higher proportion of males (52%) than females (25%) who reported using contraception. Factors significantly associated with the use of contraception were having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.33-14.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.01-4.27; p = .046), or with one's spouse (AOR = 5.13, 95% CI: 2.35-11.16; p = .000), not attending the Catholic-run clinic (AOR = 3.67, 95% CI: 1.79-7.54; p = .000), and spouses' non-desire for children (AOR = 2.19, 95% CI: 1.10-4.36; p = .025). Qualitative data revealed six major factors influencing contraception use among PLHIV in Gulu including personal and structural barriers to contraceptive use, perceptions of family planning, decision making, covert use of family planning methods and targeting of women for family planning services.ConclusionsMultilevel, context-specific health interventions including an integration of family planning services into HIV clinics could help overcome some of the individual and structural barriers to accessing family planning services among PLHIV in Gulu. The integration also has the potential to reduce HIV incidence in this post-conflict region.
Highlights
Northern Uganda experienced severe civil conflict for over 20 years and is a region of high HIV prevalence
In multivariate analysis (Table 3), having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.33-14.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.01-4.27; p = .046), or with one’s spouse (AOR = 5.13, 95% CI: 2.35-11.16; p = .000), not attending the Catholic-based clinic (AOR = 3.67, 95% CI: 1.79-7.54; p = .000) and spouse’s non-desire for children (AOR = 2.19, 95% CI: 1.10-4.36; p = .025) remained significantly associated with the current use of contraception
Being in a stable relationship (AOR = 2.30, 95% CI: 1.09-4.85), and discussion of family planning with a health worker (AOR = 5.62, 95% CI: 2.03-15.62) were significantly associated with use of hormonal contraception
Summary
Northern Uganda experienced severe civil conflict for over 20 years and is a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region. Northern Uganda had the lowest use of contraceptives by currently married women aged 1549 years: only 10.9% of women were using family planning methods in 2006 [2]. The total unmet need for family planning in the Northern region was 46% among currently married women (compared with 41% nationally), with 29.5% of these women unable to access family planning services to help space births and 16.5% unable to limit their family size. Only 19.1% of total demand for family planning was being met in Northern Uganda, the lowest percent in the whole country and the total fertility rate was 7.5 children, one of the highest rates in the country [2]
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