Use of effective family planning methods and frequency of sex among HIV-infected and HIV-uninfected African women

Abstract

Background: Frequency of sex, contraceptive use and HIV infection are key determinants of fertility. Use of an effective family planning (EFP) method (injectable, oral, intra-uterine contraceptive device (IUCD), or Norplant) potentially eliminates women's concerns of unintended pregnancy. We report the association between EFP and frequency of sex among HIV-infected and HIV-uninfected non-pregnant African women.

Methods: Prospective fertility intentions study nested within a phase 3 randomized double-masked placebo-controlled trial (2003-2005) to treat genital tract infections in HIV-infected and HIV-uninfected non-pregnant women. Enrollment of study participants was stratified by HIV infection status. Data on demographics, family planning and sexual history were obtained at baseline and at 3, 6, 9 and 12 months. Chi square and Wilcoxon Rank-Sum tests were used to compare categorical and continuous variables, respectively. Generalized Estimating Equations method was used to estimate relative risk (RR) of frequent sex (≥ 2 acts/week) among users of different EFP methods (injectable, oral, implant or intra-uterine contraceptive device).

Results: After adjusting for age, current health status, and fertility intentions, EFP use was significantly associated with frequent sex among HIV-infected women (RR 1.32; 95% Confidence Interval [CI] 1.14-1.52); this association was not statistically significant among HIV-uninfected women (RR 1.10; 95% CI 0.96-1.24). Fertility intentions among HIV-infected, and education among HIV-uninfected womenwere independent predictors of sex frequency.

Conclusion: These data suggest that the association between EFP use and frequency of sex among women varies by HIV infection status. Service-delivery of diverse EFP methods should be integrated within HIV counseling, testing and treatment facilities.

Trial registration: Registration number NCT00140764 under the clinicaltrials.gov, first Posted: September 1, 2005, last Update Posted: August 10, 2011.

Keywords: Contraception; HIV/AIDS; Sexual behavior; Sub-Saharan Africa.

Fig. 1

Study visit (0) or entry is the enrollment or baseline visit. Effective Family planning methods which were based on self-reported contraceptive use at study entry and during study follow-up include Injectable, oral, Intra-Uterine Contraceptive Device (IUCD), and Norplant and all the other family planning methods are classified as ‘other’; self-report sexual frequency assessed at each study visit, was defined as the proportion of women who self-reported 2 or more sexual encounters per week. HIV-infection status was based on HIV test results at study entry (enrollment)