Trends in contraceptive use among women with human immunodeficiency virus

Abstract

Objective: To estimate trends in contraceptive use, especially long-acting reversible contraceptives (LARCs) and condoms, among human immunodeficiency virus (HIV)-seropositive and HIV-seronegative women.

Methods: Human immunodeficiency virus-seropositive and HIV-seronegative women in a multicenter longitudinal cohort were interviewed semiannually between 1998 and 2010 about sexual behaviors and contraceptive use. Trends in contraceptive use by women aged 18-45 years who were at risk for unintended pregnancy but not trying to conceive were analyzed using generalized estimating equations.

Results: Condoms were the dominant form of contraception for HIV-seropositive women and showed little change across time. Less than 15% of these women used no contraception. Between 1998 and 2010, LARC use increased among HIV-seronegative women from 4.8% (6 of 126) to 13.5% (19 of 141, P=.02), but not significantly among seropositive women (0.9% [4 of 438] to 2.8% [6 of 213], P=.09). Use of highly effective contraceptives, including pills, patches, rings, injectable progestin, implants, and intrauterine devices, ranged from 15.2% (53 of 348) in 1998 to 17.4% (37 of 213) in 2010 (P=.55). Human immunodeficiency virus-seronegative but not HIV-seropositive LARC users were less likely than nonusers to use condoms consistently (hazard ratio 0.51, 95% confidence interval [CI] 0.32-0.81, P=.004 for seronegative women; hazard ratio 1.09, 95% CI 0.96-1.23 for seropositive women).

Conclusion: Although most HIV-seropositive women use contraception, they rely primarily on condoms and have not experienced the increase in LARC use seen among seronegative women. Strategies to improve simultaneous use of condoms and LARC are needed to minimize risk of unintended pregnancy as well as HIV transmission and acquisition of sexually transmitted infections.

Level of evidence: II.

Fig. 1

Changes in contraception use over time in human immunodeficiency virus (HIV)-seropositive women. Contraceptive methods were divided into 6 mutually exclusive categories. Those using long-acting reversible contraceptive (LARC) and/or any other methods were placed in the “LARC” category; those using depot medroxyprogesterone acetate and/or any other methods, excluding LARC, were placed in the “DMPA” category; those using any form of PPR and/or any other methods, excluding LARC and DMPA, were placed in the “oral contraceptive pill, patch, or ring (PPR)” category; those using male condoms and/or any other methods, excluding LARC, DMPA and PPR, were placed in the “condom” category; those using any other method not previously accounted for were placed in the “others” category; those using no contraception were placed in the None category.

Fig. 2

Fig. 2a. Long-acting reversible contraceptive (LARC) use over time in human immunodeficiency virus (HIV)-seronegative women. Fig. 2b. LARC¹ use over time in HIV² seropositive women. IUD, intrauterine device.