College of Health Science, Wollega University, Nekemte, Oromia, Ethiopia.
Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
PLoS One. 2020 Aug 6;15(8):e0237212. doi: 10.1371/journal.pone.0237212. eCollection 2020.
Contraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM).
A facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia.
Among sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09-1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50-0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20-1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28-1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility.
Although contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.
避孕可以帮助满足艾滋病毒感染者（WLHIV）的计划生育目标，也有助于支持预防艾滋病毒母婴传播（PMTCT）。然而，在埃塞俄比亚，针对性活跃的 WLHIV 的避孕实践的研究很少。因此，我们旨在研究西部埃塞俄比亚性活跃的 WLHIV 的避孕实践，并利用健康信念模型（HBM）确定影响这种实践的因素。
2018 年 3 月 19 日至 6 月 22 日，在西部埃塞俄比亚对 360 名性活跃的 WLHIV 进行了基于设施的横断面调查。合格的参与者是年龄在 18 至 49 岁之间的 WLHIV，他们报告在过去六个月内有生育能力且有性行为，但未怀孕且在未来两年内不想要另一个孩子。采用修正泊松回归分析来确定影响西部埃塞俄比亚性活跃的 WLHIV 避孕实践的因素。
在 360 名性活跃的 WLHIV 中（n = 360），有 75%的人使用了避孕措施，而有 25%的人存在未满足的需求。在避孕措施使用者中，44.8%使用了注射剂，37.4%使用了避孕套，28.5%使用了植入物。在过去五年中的 152 次记录分娩中，有 17.8%被报告为时间不合适，有 25.7%被报告为不想要。与 HIV 诊断后无子女的 WLHIV 相比，HIV 诊断后有两个或更多子女的（调整后患病率比 [APR] = 1.31；95%CI 1.09-1.58）与避孕措施使用的风险增加相关。然而，与已婚的性活跃 WLHIV 相比，性活跃的未婚 WLHIV（APR = 0.69；95%CI 0.50-0.95）使用任何避孕措施的可能性较小。重要的是，对意外怀孕的高感知易感性（APR = 1.49；95%CI 1.20-1.86）和中感知易感性（APR = 1.55；95%CI 1.28-1.87）与低感知易感性的 WLHIV 相比，与更高的避孕使用风险相关。
尽管发现性活跃的 WLHIV 中有较高的避孕使用率，但我们的研究结果强调需要加强计划生育服务，因为意外怀孕的比率较高，对避孕的需求未得到满足的比率较高，以及一些方法的效果较低。我们的研究结果还表明，HBM 将是医疗保健提供者、规划人员和政策制定者制定避孕咨询和选择指南和政策的宝贵框架。
