Abstract
BackgroundIn Cambodia, while anti-retroviral therapy (ART) services are increasingly available, the unmet needs of family planning among general population are high. These facts raise concern on possible exposure of many HIV-positive women on ART to the potential risk of unintended pregnancy. This study aimed to clarify family planning practices in Cambodia and determine predictors of risk of inconsistent condom use among women on ART.MethodsA cross-sectional survey with a structured questionnaire was conducted at five government-run health centers in Phnom Penh, Cambodia, from June to September, 2012. Multiple logistic regression analysis was used to identify predictors of risk of inconsistent condom use among regular users of contraceptive methods.ResultsOf 408 respondents, 40, 17 and 10 used the pill, IUD, and injection, respectively, while 193 used condoms. 374 were not planning to have a child. Among 238 sexually active women who were not planning to have a baby, 59 were exposed to the risk of unintended pregnancy. Multivariate logistic regression analysis that did not include variables related to partners identified "seeking family planning information" (adjusted odds ratio (AOR): 2.6, 95% confidence intervals (95% CI): 1.1-6.2), awareness of mother-to-child transmission (MTCT) (AOR: 4.7, 95% CI: 1.9-11.6) and "having a son" (AOR: 2.0, 95% CI: 1.1-3.9) were significant predictors of inconsistent condom use. Another model that included all variables identified “able to ask a partner to use condom at every sexual intercourse” was the only predictor (AOR: 23.7, 95% CI: 5.8-97.6).ConclusionsAbout one-quarter of women on ART are at risk to unintended pregnancy although most do not plan to get pregnant. Furthermore, women on ART could be more empowered through improvement of communication and negotiation skills with partners to demand the use of condom during sexual intercourse. The use of other contraceptive methods that do not need partner involvement should be promoted.
Highlights
In Cambodia, while anti-retroviral therapy (ART) services are increasingly available, the unmet needs of family planning among general population are high
In 2010, the national PMTCT (Prevention of Mother-to-Child Transmission) program in Cambodia reported a high ratio of HIV-positive mothers on ART among HIV-positive mothers at delivery, which suggested that many HIVpositive mothers become pregnant after starting ART [11,12]
Discussion previous studies reported that HIV-positive women tend to plan to have a baby because of their personalized stigma [15,16,17], our study that targeted HIV-positive Cambodian women on ART showed that the majority (92.3%) of respondents were not planning to have a child, some reported the experience of losing a child due to mother-to-child transmission (MTCT) of HIV and surrounding pressure to have a baby
Summary
In Cambodia, while anti-retroviral therapy (ART) services are increasingly available, the unmet needs of family planning among general population are high. These facts raise concern on possible exposure of many HIV-positive women on ART to the potential risk of unintended pregnancy. The estimated number of people carrying HIV (PLHIV) was 34 million worldwide at the end of 2010 [1] This number is increasing due to the recent reduction in mortality rate based on the availability of new and effective anti-retroviral therapy (ART) around the world, including poor and developing countries, where coverage of adults in need of ART was approximately 51% at the end of 2010 [2].
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