Reliance on condoms for contraceptive protection among HIV care and treatment clients: A mixed methods study on contraceptive choice and motivation within a generalised epidemic
Document Type
Article (peer-reviewed)
Publication Date
2014
Abstract
Objectives: To (i) describe the contraceptive practices of HIV care and treatment (HCTx) clients in Manzini, Swaziland, including their unmet needs for family planning (FP), and compare these with population-level estimates; and (ii) qualitatively explore the causal factors influencing contraceptive choice and use. Methods: Mixed quantitative and qualitative methods were used. A cross-sectional survey conducted among HCTx clients (N=611) investigated FP and condom use patterns. Using descriptive statistics, findings were compared with population-level estimates derived from Swaziland Demographic and Health Survey data, weighted for clustering. In-depth interviews were conducted with HCTx providers (n=16) and clients (n=22) and analysed thematically. Results: 64% of HCTx clients reported current contraceptive use; most relied on condoms alone, few practiced dual method use. Rates of condom use for FP among female HCTx clients (77%, 95% CI 71% to 82%) were higher than population-level estimates in the study region (50% HIV-positive, 95% CI 43% to 57%; 37% HIV-negative, 95% CI 31% to 43%); rates of unmet FP needs were similar when condom use consistency was accounted for (32% HCTx, 95% CI 26% to 37%; vs 35% HIV-positive, 95% CI 28% to 43%; 29% HIV-negative, 95% CI 24% to 35%). Qualitative analysis identified motivational factors influencing FP choice: fears of reinfection; a programmatic focus on condoms for people living with HIV; changing sexual behaviours before and after antiretroviral therapy (ART) initiation; failure to disclose to partners; and contraceptive side effect fears. Conclusions: Fears of reinfection prevailed over consideration of pregnancy risk. Given current evidence on reinfection, HCTx services must move beyond a narrow focus on condom promotion, particularly for those in seroconcordant relationships, and consider diverse strategies to meet reproductive needs.
Recommended Citation
Church, Kathryn, Alison Wringe, Phelele Fakudze, Joshua Kikuvi, Zelda Nhlabatsi, Rachel Masuku, Susannah H. Mayhew, Timothy Abuya, Ian Askew, Isolde Birdthistle, Manuela Colombini, Natalie Friend Du-Preez, James Kimani, Jackline Kivunaga, Joelle Mak, Christine Michaels, Richard Mutemwa, Charity Ndwiga, Carol Dayo Obure, Sedona Sweeney, Anna Vassall, Charlotte Warren, Charlotte Watts, and Weiwei Zhou. 2014. "Reliance on condoms for contraceptive protection among HIV care and treatment clients: A mixed methods study on contraceptive choice and motivation within a generalised epidemic," Sexually Transmitted Infections 90(5): 394–400.
DOI
10.1136/sextrans-2013-051339
Language
English