Contraceptive use and reproductive desire among HIV-1 discordant couples in Nairobi, Kenya
Abstract
Most HIV transmission worldwide occur among HIV discordant couples {where one partner is HIV infected and the other is not), either sexually or in association with pregnancy. childbirth or breastfeeding. This makes discordant couples an important cohort for HIV transmission prevention strategies. Use of contraceptives reduces vertical transmission by preventing unwanted pregnancies while use of condoms reduces transmission from the positive to the negative partner. Contraception uptake in sub Saharan Africa is low.
Discordant couples face unique challenges relating to their reproductive health. They have difficult choices to make concerning sexuality, fertility, parenthood desires and family life. Counseling and health provider knowledge on how to balance the reproductive desire of the couples and yet reduce transmission is crucial.
Objectives
The main objective of the study was to describe the contraceptive practice, experience and attitude and the determinants of reproductive desire among HIV sero-discordant couples enrolled in the Pre-exposure Prophylaxis Study (PrEP) and in addition describe the role of the healthcare providers in discordant couple reproductive health.
Methodology
This was a cross-sectional study done at the PrEP Study Clinic in Kenyatta National Hospital,Nairobi between March and July 2011. Women of reproductive age (18-46 years) and their partners in a heterosexual sero-discordant relationship and health care providers who work amongst discordant
couple cohorts were enrolled in this study. Structured questionnaires were used to collect quantitative data and Focus group discussions (FGDs) were used to collect qualitative data .
Results
The study surveyed 350 participants (175 couples) of who 84 couples had a female HIV negative and 91 couples had a female HIV positive partner. Three FGDs were held, stratified by gender and sero-status. Overall, 190(54.3%) of the participants wanted to have more children. Majority 159(90.9%) of
the women used some method of contraception. Only 49(28%) of these women used dual contraception. Of the women who did not use dual contraception, fear of side effects 56(44.4%), planning on conceiving 39(31.0%), condoms are sufficient as contraception 33(26.2%) and partner objecting to their use of contraception 25(19.8%) were identified as the commonest reasons for not using dual contraception. The HIV status, age and the number of children were associated with wanting more children.
In the FGDs, the availability of PMTCT, ARVs, sperm washing were promoters to increasing desire for children. Relationship dynamics, domestic violence and discussing contraception with the partners were promoters to contraception use. Overall, 12(6.9%) of the
women were pregnant, with an equal number of HIV positive and negative women. All pregnancies were unplanned. Of these 9(75%) were on condoms only at the time the pregnancy happened.
Majority 19(70.4%) of the health care providers were adequately trained. The contraception they prescribed to the HIV positive or negative woman did not differ.
Conclusion
In this HIV discordant couple cohort with intensive risk reduction counseling to prevent HIV, less than one third of couples reported use of dual contraception. This may be partially due to reproductive desire in the cohort, with over half desiring future children, particularly younger individuals with fewer children. However, a surprising number of individuals without reproductive desire did not use dual contraception. Improved counseling to address both fertility intention and need for dual contraception is necessary for discordant couples. In addition, empowering the health care providers with knowledge on the special reproductive needs of discordant couples will meet their reproductive health
Publisher
University of Nairobi, Kenya