Centre for International Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
Confl Health. 2011 Sep 20;5:18. doi: 10.1186/1752-1505-5-18.
Northern Uganda experienced severe civil conflict for over 20 years and is also a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region.
Between February and May 2009, a total of 476 HIV clinic attendees from three health facilities in Gulu, Northern Uganda, were interviewed using a structured questionnaire. Semi-structured interviews were conducted with another 26 participants. Factors associated with use of family planning methods were examined using logistic regression methods, while qualitative data was analyzed within a social-ecological framework using thematic analysis.
There was a high level of knowledge about family planning methods among the PLHIV surveyed (96%). However, there were a significantly higher proportion of males (52%) than females (25%) who reported using contraception. Factors significantly associated with the use of contraception were having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.33-14.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.01-4.27; p = .046), or with one's spouse (AOR = 5.13, 95% CI: 2.35-11.16; p = .000), not attending the Catholic-run clinic (AOR = 3.67, 95% CI: 1.79-7.54; p = .000), and spouses' non-desire for children (AOR = 2.19, 95% CI: 1.10-4.36; p = .025). Qualitative data revealed six major factors influencing contraception use among PLHIV in Gulu including personal and structural barriers to contraceptive use, perceptions of family planning, decision making, covert use of family planning methods and targeting of women for family planning services.
Multilevel, context-specific health interventions including an integration of family planning services into HIV clinics could help overcome some of the individual and structural barriers to accessing family planning services among PLHIV in Gulu. The integration also has the potential to reduce HIV incidence in this post-conflict region.
乌干达北部经历了 20 多年的严重内战，也是艾滋病毒高发地区。本研究调查了该地区艾滋病毒感染者（PLHIV）对计划生育服务的了解程度、获取途径以及与其使用相关的因素。
2009 年 2 月至 5 月，对来自乌干达北部古卢的三个卫生设施的 476 名艾滋病毒诊所就诊者进行了结构问卷调查。对另外 26 名参与者进行了半结构式访谈。使用逻辑回归方法检查与使用计划生育方法相关的因素，同时在社会生态框架内使用主题分析对定性数据进行分析。
接受调查的 PLHIV 对计划生育方法有很高的了解程度（96%）。然而，报告使用避孕措施的男性（52%）明显高于女性（25%）。与使用避孕措施显著相关的因素包括曾上过学[校正优势比（AOR）=4.32，95%置信区间（CI）：1.33-14.07；p=0.015]、与卫生工作者讨论计划生育（AOR=2.08，95%CI：1.01-4.27；p=0.046）或与配偶讨论计划生育（AOR=5.13，95%CI：2.35-11.16；p=0.000）、不参加天主教会经营的诊所（AOR=3.67，95%CI：1.79-7.54；p=0.000）和配偶不希望有孩子（AOR=2.19，95%CI：1.10-4.36；p=0.025）。定性数据显示，影响古卢 PLHIV 避孕使用的六个主要因素包括避孕使用的个人和结构障碍、对计划生育的看法、决策、隐蔽使用计划生育方法以及计划生育服务针对妇女。
多层面、具体情况的卫生干预措施，包括将计划生育服务纳入艾滋病毒诊所，可以帮助克服古卢 PLHIV 获得计划生育服务的一些个人和结构障碍。这种整合还有可能降低冲突后地区的艾滋病毒发病率。
