Factors associated with condom use among men and women living with HIV in Lilongwe, Malawi: a cross-sectional study

• Type of Material: Article
• Authors: Lisa Haddad, Emory University; Jennifer H Tang, Kamuzu Central Hospital; Jamie Krashin, Emory University; Wingston Ng'ambi, Lighthouse Trust; Hannock Tweya, Lighthouse Trust; Bernadette Samala, Lighthouse Trust; Jane Chiwoko, Lighthouse Trust; Thomas Chaweza, Lighthouse Trust; Mina C Hosseinipour, Kamuzu Central Hospital; Eva Lathrop, Emory University; Denise Jamieson, Emory University; Sam Phiri, Lighthouse Trust
• Language: English
• Date: 2018-01-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjsrh-2017-101825
• Title of Journal or Parent Work: BMJ Sexual and Reproductive Health
• ISSN: 2515-1991
• Volume: 44
• Issue: 1
• Start Page: 42
• End Page: 53
• Grant/Funding Information: Dr Haddad received support through a career development award from the National Institute of Health (1K23HD078153-01A1).; This study was supported by a grant from the Society in Family Planning (PI: Lisa Haddad).
• Keywords: BEHAVIORS; YOUNG; YOUTH; Social Sciences, Biomedical; Biomedical Social Sciences; PREVENTION; AFRICA; Science & Technology; Obstetrics & Gynecology; Social Sciences; Family Studies; ANTIRETROVIRAL THERAPY; Life Sciences & Biomedicine; METAANALYSIS; UGANDA
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health

Abstract

Background Understanding the influences on condom use among men and women living with HIV is critical to tailoring sexually transmitted infection/HIV prevention efforts. Methods This is a sub-analysis of a cross-sectional survey including 255 women and 220 men who were sexually active, HIV-positive, and attending HIV care visits in Lilongwe, Malawi. We estimated adjusted prevalence ratios (aPRs) to evaluate for factors associated with consistent condom use (always using condoms in the past month) and use at last coitus for men and women in separate models. Results Among women: 38% and 55% reported consistent condom use and condom use at last coitus, respectively. For women, consistent use and use at last coitus were positively associated with the ability to refuse sex without condoms and shared decision-making compared with making the decision alone regarding condom use, and negatively associated with desire for children in the future. Consistent use also increased with longer antiretroviral therapy (ART) use (≥1 year compared with no ART use). Among men: 51% and 69% reported consistent condom use and condom use at last coitus, respectively. For men, the ability to refuse sex without condoms was associated with consistent use and use at last coitus, and believing that condoms should be used with other contraception was associated with consistent use. Conclusions Our findings demonstrate ongoing low condom utilisation among HIV-positive individuals, and highlight that ART and contraceptive use do not deter condom use. Efforts to increase condom utilisation must recognise individual-level factors that influence use and should focus on relationship dynamics and promotion of empowerment and self-efficacy.