Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi

• Type of Material: Article
• Authors: Lisa Haddad, Emory University; Linly Mlundira, The Lighthouse Trust; Jane Chiwoko, The Lighthouse Trust; Bernadette Samala, The Lighthouse Trust; Fanny Kachale, Ministry of Health; Amy G. Bryant, University of North Carolina Chapel Hill; Mina C. Hosseinipour, University of North Carolina Chapel Hill; Gretchen S. Stuart, University of North Carolina Chapel Hill; Irving Hoffman, University of North Carolina Chapel Hill; Sam Phiri, The Lighthouse Trust; Caryl Feldacker, The Lighthouse Trust; Denise J. Jamieson, Emory University; Hannock Tweya, The Lighthouse Trust; Carrie A Cwiak, Emory University; Thomas Chaweza, The Lighthouse Trust
• Language: English
• Date: 2015-03-26
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0121039
• Title of Journal or Parent Work: PLoS ONE
• Volume: 10
• Issue: 3
• Start Page: e0121039
• End Page: e0121039
• Grant/Funding Information: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; This study received financial support from an anonymous foundation and from the center for AIDS research at Emory University (P30 AI050409).

Abstract

Background: Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic. Methods: 200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010. Results: Most women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner's refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage. Discussion: High rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment.