Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
PLoS One. 2010 Nov 5;5(11):e13868. doi: 10.1371/journal.pone.0013868.
Preventing unintended pregnancy among HIV-positive women constitutes a critical and cost-effective approach to primary prevention of mother-to-child transmission of HIV and is a global public health priority for addressing the desperate state of maternal and child health in HIV hyper-endemic settings. We sought to investigate whether the prevalence of contraceptive use and method preferences varied by HIV status and receipt of highly active antiretroviral therapy (HAART) among women in Soweto, South Africa.
We used survey data from 563 sexually active, non-pregnant women (18-44 years) recruited from the Perinatal HIV Research Unit in Soweto (May-December, 2007); 171 women were HIV-positive and receiving HAART (median duration of use = 31 months; IQR = 28, 33), 178 were HIV-positive and HAART-naïve, and 214 were HIV-negative. Medical record review was conducted to confirm HIV status and clinical variables. Logistic regression models estimated adjusted associations between HIV status, receipt of HAART, and contraceptive use.
Overall, 78% of women reported using contraception, with significant variation by HIV status: 86% of HAART users, 82% of HAART-naïve women, and 69% of HIV-negative women (p<0.0001). In adjusted models, compared with HIV-negative women, women receiving HAART were significantly more likely to use contraception while HAART-naïve women were non-significantly more likely (AOR: 2.40; 95% CI: 1.25, 4.62 and AOR: 1.59; 95% CI: 0.88, 2.85; respectively). Among HIV-positive women, HAART users were non-significantly more likely to use contraception compared with HAART-naïve women (AOR: 1.55; 95% CI: 0.84, 2.88). Similar patterns held for specific use of barrier (primarily male condoms), permanent, and dual protection contraceptive methods.
Among HIV-positive women receiving HAART, the observed higher prevalence of contraceptive use overall and condoms in particular promises to yield fewer unintended pregnancies and reduced risks of vertical and sexual HIV transmission. These findings highlight the potential of integrated HIV and reproductive health services to positively impact maternal, partner, and child health.
预防 HIV 阳性妇女意外怀孕，是预防母婴垂直传播 HIV 的关键且具有成本效益的方法，也是在 HIV 高度流行地区解决母婴健康状况令人绝望问题的全球公共卫生重点。我们试图调查在南非索韦托，HIV 阳性和接受高效抗逆转录病毒治疗（HAART）的妇女中，避孕方法的使用和方法偏好是否因 HIV 状况而有所不同。
我们使用了 2007 年 5 月至 12 月从索韦托围产期 HIV 研究单位招募的 563 名性活跃、未怀孕的妇女（18-44 岁）的调查数据；171 名妇女 HIV 阳性并接受 HAART（中位使用时间为 31 个月；IQR = 28，33），178 名妇女 HIV 阳性且未接受 HAART，214 名妇女 HIV 阴性。进行病历审查以确认 HIV 状况和临床变量。使用逻辑回归模型估计了 HIV 状况、接受 HAART 和使用避孕措施之间的调整关联。
总体而言，78%的妇女报告使用了避孕措施，HIV 状况存在显著差异：HAART 使用者为 86%，HAART 未使用者为 82%，HIV 阴性者为 69%（p<0.0001）。在调整后的模型中，与 HIV 阴性妇女相比，接受 HAART 的妇女使用避孕措施的可能性显著更高，而 HAART 未使用者则无显著差异（AOR：2.40；95%CI：1.25，4.62 和 AOR：1.59；95%CI：0.88，2.85）。在 HIV 阳性妇女中，HAART 使用者与 HAART 未使用者相比，使用避孕措施的可能性无显著差异（AOR：1.55；95%CI：0.84，2.88）。对于屏障（主要是男用避孕套）、永久性和双重保护避孕方法的具体使用，也存在类似的模式。
在接受 HAART 的 HIV 阳性妇女中，观察到整体避孕措施和特定使用避孕套的更高流行率，有望减少意外怀孕，并降低垂直和性 HIV 传播的风险。这些发现突出了将 HIV 和生殖健康服务相结合以积极影响母婴、伴侣和儿童健康的潜力。
