Correlates and Barriers of Contraceptive Use among HIV Discordant Couples in Kenya

Abstract

Unwanted pregnancies among HIV discordant couples are a surrogate marker for high risk sexual intercourse. Among HIV discordant couples there is an ever present risk of HIV transmission to the infants born of the HIV positive women as well as to the HIV negative partner. Mother to Child transmission (MTCT) is the main mode of HIV transmission to infants. Avoiding unwanted pregnancies among HIV-infected women would avert or reduce the number of HIV positive births. Contraceptive use among HIV positive women is highly recommended through counselling and awareness creation. Some contraceptive methods such as male and female condoms can also prevent HIV infection to the negative partner. The main objective of this study was to determine the factors associated with contraceptive use in a clinical trial cohort of HIV serodiscordant couples based in Thika and Eldoret Districts in Kenya. Additionally, this study sought to explore barriers to contraceptive use among the same cohort of HIV discordant couples. Data was collected from of 481 HIV discordant couples enrolled in the Partners in Prevention HSV/HIV Transmission Study at Thika and Eldoret sites. Contraceptive use was measured through self report at baseline, every 3 months and at the 24 month study visit. Additionally, qualitative data was collected through 32 in depth interviews, 8 focus group discussions among HIV discordant couples and 8 key informant interviews among clinicians and counselors working at the two clinical trial sites. At baseline the prevalence of non-barrier contraceptive methods among the HIV positive women was 24.3% and 25.7% among the HIV negative women. At month 24 of follow up the prevalence of contraceptive use was 38.6% among the HIV positive and 18.2% among the HIV negative women. Using logistic regression models, the estimated odds of contraceptive use among HIV positive women was 1.61 (95% confidence interval (CI) 1.0-2.5). Additionally, being married (odds ratio (OR) = 2.4, 95% CI 1.2-5.0), attending Thika site clinic (OR = 6.1, 95%CI 4.2-9.0), and having two or more children (OR = 1.9, 95%CI 1.3-2.8) were associated with increased use of non barrier contraceptives. The main barriers to contraceptive use among the couples identified qualitatively were; (1) lack of adequate knowledge on modern contraception among both men and women leading to myths and misconceptions; (2) side effects associated with the methods either experienced or perceived; (3) male partners reported opposition to contraception methods available to their partners. Most women believed that male partners expected to be consulted before women started or changed a contraceptive method. The implications of these findings are that future programs should focus on interventions to increase contraceptive use among women in HIV discordant relationships, with a special emphasis on HIV negative single women with 2 or fewer children and their male partners. Additionally, emphasis on educating couples on contraceptive methods would reduce barriers associated with misconceptions associated with modern methods as well as building skills for women to negotiate contraceptive use with their male partners.