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

Sex Transm Infect. 2014 Aug;90(5):394-400. doi: 10.1136/sextrans-2013-051339. Epub 2014 Apr 2.

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.

Keywords: AFRICA; CONDOMS; CONTRACEPTION; FAMILY PLANNING; HIV CLINICAL CARE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Choice Behavior
  • Contraception / methods*
  • Contraception Behavior / psychology
  • Contraception Behavior / statistics & numerical data*
  • Cross-Sectional Studies
  • Eswatini / epidemiology
  • Family Planning Services / methods*
  • Female
  • HIV Seropositivity / epidemiology*
  • HIV Seropositivity / psychology
  • Health Knowledge, Attitudes, Practice
  • Health Promotion
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Male
  • Middle Aged
  • Motivation
  • Pregnancy
  • Sex Education
  • Sexual Partners