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. 2018 Feb;22(2):663-670.
doi: 10.1007/s10461-017-1846-y.

From Pill to Condom, or Nothing at all: HIV Diagnosis and Discontinuation of Highly Effective Contraceptives Among Women in Northeast Brazil

Bianca M Stifani  1 , Sarah MacCarthy  2 , Amy Nunn  3 , Nerys Benfield  4 , Inês Dourado  5
Affiliations

From Pill to Condom, or Nothing at all: HIV Diagnosis and Discontinuation of Highly Effective Contraceptives Among Women in Northeast Brazil

Bianca M Stifani et al. AIDS Behav. 2018 Feb.

Abstract
in English, Spanish

This is a cross-sectional study examining highly effective contraceptive (HEC) use among HIV-positive women in Salvador, Brazil. We used multivariate logistic regression to look for predictors of alternative contraceptive choices among women who discontinued HEC after HIV diagnosis. Of 914 participants surveyed, 38.5% of participants used HEC before but not after diagnosis. Of these, 65.9% used condoms alone; 19.3% used no protection; and 14.8% reported abstinence. Use of condoms alone was associated with a history of other sexually transmitted infections (AOR 2.18, 95% CI 1.09-4.66, p = 0.029). Abstinence was associated with recent diagnosis (AOR 8.48, 95% CI 2.20-32.64, p = 0.002). Using no method was associated with age below 25 (AOR 5.13, 95% CI 1.46-18.00, p = 0.011); income below minimum wage (AOR 2.54, 95% CI 1.31-4.92, p = 0.006); HIV-positive partner status (AOR 2.69, 95% CI 1.03-7.02, p = 0.043); and unknown partner status (AOR 2.90, 95% CI 1.04-8.05, p = 0.042). Improved contraceptive counseling is needed after HIV diagnosis. Continuation of HEC should be encouraged for women wishing to prevent pregnancy, and may increase contraceptive coverage among HIV-positive women.

Se realizó un estudio transversal para analizar el uso de anticonceptivos de alta eficacia entre mujeres VIH-seropositivas en Salvador, Brasil. Se recurrió a la regresión logística múltiple para identificar los factores de predicción del uso de métodos de menor eficacia entre las mujeres que suspendieron el uso de métodos muy eficaces después de haber recibido un diagnóstico de VIH. De las 914 participantes, un 38,5% habían usado métodos muy eficaces antes del diagnóstico, sin embargo, no continuaron el uso. De estas, un 65,9% usaron solo preservativos después del diagnóstico, un 19,3% no usaron ningún método y un 14,8% relataron abstinencia sexual. Se encontró una asociación significativa entre el uso solo de preservativos y un pasado de infección por otras enfermedades de transmisión sexual (ORa 2,18, IC95%: 1,09-4,66, p = 0,029); entre la abstinencia sexual y el diagnostico reciente de VIH (ORa: 8,48, IC95%: 2,20-32,64, p = 0,002). La ausencia de uso de cualquier método anticonceptivo se asoció con edad menor que 25 años (ORa: 5,13, IC95%: 1,46-18,00, p = 0,011), con salario inferior al mínimo nacional (ORa: 2,54, IC95%: 1,31-4,92, p = 0,006), con una pareja portadora del VIH (ORa 2,69, IC95%: 1,03-7,02, p = 0,043) o de seroestado desconocido (ORa: 2,90,IC95%:1,04-8,05, p = 0,042). En conclusión, se necesita una mejor orientación a las mujeres que viven con VIH sobre el tema de anticoncepción, especialmente en el periodo del diagnóstico de VIH. La continuación de los métodos de alta eficacia debería ser incentivada, una vez que esta estrategia podría aumentar la cobertura anticonceptiva global entre mujeres en este grupo vulnerable.

Keywords: Contraceptive methods; Contraceptive usage; HIV seropositivity; Women.

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Conflict of interest statement

Conflict of interest No competing financial interests exist.

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