Abstract
IntroductionDespite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities.MethodsThe study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0.ResultsSix hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04).ConclusionThis study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.
Highlights
There are an estimated 36.7 million people living with Human Immuno-Deficiency Virus (HIV)/AIDS
39% of People Living with HIV/AIDS (PLWHA) used modern family planning at the time of the survey. This contraceptive prevalence rate (CPR) among this group was low compared to the target set by the Federal HIV/AIDS Prevention and Control Office (FHAPCO) of Ethiopia that target modern FP use among sexually active clients as 50% [5]
This low usage could be improved through an urgent need of making various methods available, as well as the education of PLWHA so that they can use any of the modern FP methods [22] and counseling on the true side effects of each method
Summary
There are an estimated 36.7 million people living with HIV/AIDS. The pandemic burden lies in Africa where it disproportionally affects Sub-Sahara Africa (SSA) inhabitants. Despite increasing efforts to address the reproductive health needs of people living with HIV, 80% unmet need for family planning (FP) exists among HIV+ clients in sub-Saharan Africa [2]. HIV positive clients who do not use modern FP have a higher risk of unwanted pregnancies and increase chance of MTCT [3] and unsafe abortion. Annually expects 3 million pregnancies of which 602 births per 100,000 pregnancies are prone to MTCT of HIV with a large majority of this pregnancies been unwanted [4]. A cross-sectional study conducted in Ethiopia including both HIV-positive and HIV-negative women reported that 69.2% of their most recent pregnancy was unwanted [5]. Providing family planning to HIV positive women in Ethiopia is expected to save annually US $360,000 than providing ARV prophylaxis [6]. Undesired pregnancies have both maternal and child consequences including unsafe abortion, maternal and infant morbidity and mortality
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