Maraux B, Hamelin C, Bajos N, Dray-Spira R, Spire B, Lert F
INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France.
INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; Université de Versailles Saint-Quentin en Yvelines, Villejuif, France.
Contraception. 2015 Aug;92(2):160-9. doi: 10.1016/j.contraception.2015.04.010. Epub 2015 May 2.
Advances in antiretroviral treatment (ART) have led to improvements in reproductive health for women living with HIV. This paper aims to investigate the pattern of contraceptive use among women living with HIV in France.
Data were drawn from the ANRS VESPA2 study, which included a representative sample of HIV-positive people. Contraception methods were documented, including condoms, highly effective contraception methods (HEC) and traditional methods. We measured the frequency of not using any modern contraception (neither condoms nor HEC) and of HEC use and studied their correlates (i.e., geographic origin, age, parity, partnership status, education level, material deprivation, employment status, health insurance, visits to a gynecologist, being on ART, cardiovascular risk) among women at risk of an unintended pregnancy.
Of the 662 women of reproductive age, 327 were in need of contraception. Overall, 20.5% used HEC, 58.8% used condoms and 20.7% used traditional or no methods, with no difference according to geographic origin [sub-Saharan African (SSA) women vs. French and other migrant women]. Among SSA women, being <30years old [odds ratio (OR) 16.39, 95% confidence interval (95%CI) 2.77-97.01], having had at least one child (OR 3.75, 95%CI 1.75-8.04) and being employed (OR 2.36, 95%CI 0.99-5.61) were associated with HEC use; among French and other migrant women, HEC use was associated with being in a stable partnership (OR 4.5, 95%CI 1.2-17.2) and material deprivation (OR 3.3 95%CI 1.4-9.8). Gynecologist visits, health insurance status and cardiovascular risk were not associated with HEC use.
Condoms remained the predominant contraceptive method despite the absence of restrictions on hormonal contraception and intrauterine device use for HIV-positive women. The recent recommendations about dual method protection should be actively promoted, targeting HIV-positive women, HIV specialists and gynecologists to overcome the barriers to effective contraception.
The information provided in this study constitutes a major contribution to comprehensively inform the scientific community on contraception practices among women living with HIV in France in the early 2010s. Our results show that the therapeutic advances since the late 1990s and the removal of restrictions on hormonal contraception use have not led to the expected shift in contraception patterns. There is an urgent need to promote dual method protection, as condom use may decrease in the future in the context of the preventive effect of ART.
抗逆转录病毒治疗（ART）的进展已使感染艾滋病毒的女性的生殖健康状况得到改善。本文旨在调查法国感染艾滋病毒女性的避孕使用模式。
数据取自法国国家艾滋病研究机构（ANRS）的VESPA2研究，该研究纳入了具有代表性的艾滋病毒阳性人群样本。记录了避孕方法，包括避孕套、高效避孕方法（HEC）和传统方法。我们测量了不使用任何现代避孕方法（既不使用避孕套也不使用HEC）和使用HEC的频率，并研究了有意外怀孕风险的女性中它们的相关因素（即地理来源、年龄、生育次数、伴侣关系状况、教育水平、物质匮乏程度、就业状况、健康保险、看妇科医生的次数、接受ART治疗、心血管风险）。
在662名育龄女性中，327名需要避孕。总体而言，20.5%的女性使用HEC，58.8%的女性使用避孕套，20.7%的女性使用传统方法或不使用任何方法，不同地理来源的女性（撒哈拉以南非洲地区（SSA）女性与法国及其他移民女性）之间无差异。在SSA女性中，年龄小于30岁（比值比（OR）16.39，95%置信区间（95%CI）2.77 - 97.01）、至少生育过一个孩子（OR 3.75，95%CI 1.75 - 8.04）和就业（OR 2.36，95%CI 0.99 - 5.61）与使用HEC相关；在法国及其他移民女性中，使用HEC与处于稳定伴侣关系（OR 4.5，95%CI 1.2 - 17.2）和物质匮乏（OR 3.3，95%CI 1.4 - 9.8）相关。看妇科医生的次数、健康保险状况和心血管风险与使用HEC无关。
尽管对于艾滋病毒阳性女性使用激素避孕和宫内节育器没有限制，但避孕套仍然是主要的避孕方法。应积极推广近期关于双重方法保护的建议，针对艾滋病毒阳性女性、艾滋病毒专家和妇科医生，以克服有效避孕的障碍。
本研究提供的信息对全面告知科学界2010年代初法国感染艾滋病毒女性的避孕做法做出了重大贡献。我们的结果表明，自20世纪90年代末以来的治疗进展以及对激素避孕使用限制的取消并未导致避孕模式出现预期的转变。迫切需要推广双重方法保护，因为在ART的预防作用背景下，未来避孕套的使用可能会减少。
