Fertility Desires and Contraceptive Practices Among Hiv Positive Adults at Naivasha District Hospital

Abstract

Summary: In Kenya, there over a million adults of reproductive age living with HIV/AIDS. Increased availability of HAART has resulted in improved sexual and physical health, resulting in increased risk of intended and unintended pregnancies. Their reproductive intentions have not been well defined. This study aimed to determine the fertility desires and its determinants and contraceptive practices of HIV positive adults at Naivasha District hospital. Objectives: To determine fertility desires and contraceptive practices of HIV positive adults attending the care and treatment center of HIV infected adults at Naivasha level IV Hospital. Methods This was a cross-sectional study assessing the fertility desires and contraceptive practices of HIV positive adults at Naivasha District Hospital. A structured pre-coded questionnaire that assessed socio-demographics, pregnancy intentions, contraceptive use, disease status, ART drug use, was administered to consenting HIV positive adults. Descriptive analysis of population characteristics, pregnancy intentions and contraceptive use were performed. Chi squares and t-test were performed to determine predictors of future fertility desires. Logistic regression was then applied. 19 Results: Six hundred HIV positive adults were recruited. These included 300 men, age (median 41.3, (IQR) 34.5-48) and 300 women; age (median 36.2, (IQR) 29-42). Only 16.5% of women (n=297) and 24.4% of men (n=275) had pregnancy intentions. Women not on HAART (OR 0.62, CI 0.28-0.81, P value 0.009) and number of living children were significantly associated with pregnancy intentions of male (OR [95%CI], 0.04 [0.04-0.3]) and female (OR [95%CI], 0.1 [0.01-0.2]) HIV positive adults.. Among the 208 males who did not desire more children, 122 (58.7%) reported using contraception. Among the 248 women who did not desire more children, 126(50.8%) reported using contraception. The most common method of contraception was male condom, reported by 106 (35.3 %) men and 118 (39.3%) women. Various reasons were given to explain lack of use of contraceptive methods among those not desiring immediate conception (n=118 women, n=45 men). The most common reason was infrequent/ no sex at 64 (54.2%) for women and opposition to FP use at 7 (15.6%) for men More men than women were sexually active, 85.8% versus 55.5%. Men reported having more sexual partners in the last 3mo, with 17.5% having more than two partners, compared to 1.6% of women. Conclusion: HIV positive men and women desire fertility. Their fertility intentions are comparable to those of the general population among those desiring fertility. In the CCC where HIV care is provided, treatment of both partners and their infants should be ensured. The CCC need to develop 20 programs that educate patients on modes of maximizing safer pregnancies for their HIV positive clientele. For the HIV positive men and women who do not desire fertility, they should be assisted to access family planning services to avoid unplanned pregnancy. Sexual activity among HIV positive men and women with some having two or more partners, with or without desire for conception, further illustrates the positive living of these clients which is a critical component of their everyday life. Their needs have to be addressed in their HIV care and treatment and not just emphasis on HAART compliance. There was a high unmet need for contraception in this particular group of clients. This increases the risk of unintended pregnancies. Recommendations: Strategies need to be put in place that increases the uptake and use of contraceptive methods. This may include but not limited to educating the patients on the availability of FP methods, inquiring from them which FP methods they use and reasons why they choose not to use an FP method. The pregnancy intentions of HIV positive clients need to be addressed by offering them ways they can achieve safe pregnancies by reducing the risks of horizontal transmission of HIV. They need to be evaluated using CD4, Viral load and screened for opportunistic infections.