Between February and June, 2011, 277 women participated in this study (data on refusal rates were not collected). Sociodemographic characteristics and a summary of reproductive and HIV health history are displayed in . Participants had a mean age of 32.0 (standard deviation (SD) ± 6.4) years with most being unemployed (71%) and having completed at least some secondary school (89%). Most participants (82%) were in a relationship, with the majority describing their status as unmarried and either living with (41%) or without a partner (43%). The mean time since HIV diagnosis was 4.6 years (SD ± 3.6), and 64% were using antiretroviral therapy (ART) at the time of interview. Most participants (92%) had been pregnant previously with a mean of 2.0 (SD ± 1.1) living children currently.
Sociodemographic and health characteristics of HIV-positive women participating in a contraceptive preference assessment in Cape Town, South Africa (N = 277).
All participants reported awareness of at least one contraceptive method, and nearly all (n = 276, 99%) had previously used a method. Most women (93%, n = 258) reported current contraceptive use; the most common reason stated for not using a method was lack of a current sexual partner. Current method mix, history of prior methods used, and awareness of specific contraceptive methods are displayed in . Of those currently using contraception (n = 258), most women (89%) reported satisfaction with and intent to continue use of their current method, while 4% planned to discontinue their method due to desire for pregnancy (n = 7), or dissatisfaction with method (n = 2). Another 3% were not satisfied with the method yet planned to continue use. A majority (78%, n = 202 of 258 currently using contraception) of women reported using male condoms in conjunction with another method.
Contraceptive method awareness and current and prior contraceptive use among HIV-positive women in Cape Town, South Africa (N = 277).
Women were queried regarding the most attractive features of an ideal contraceptive method, with multiple answers permitted. The most advantageous features of a contraceptive method were (of 516 responses) efficacy to prevent pregnancy (32%), preventing sexually transmitted infections and/or HIV transmission/reinfection (26%), lasting for long duration without necessitating a clinic visit for readministration (11%), causing no menstrual changes (7%), having no associated weight changes (4%), no associated mood or other side effects (3%), and having no interaction with ARVs (3%).
Method change in the last year was reported by 42 (15%) women, with the key reasons for changing methods being desired pregnancy (29%), heavy menstrual bleeding (12%), irregular menses (10%), and other side effects (10%). Method change rarely occurred in response to HIV diagnosis (9%) or ARV initiation (3%). Stated reasons for method change at the time of HIV diagnosis by 24 women included concern for how the method would interact with HIV disease (30%), planned sexual abstinence or cessation of current relationship (18%), side effects excluding menstrual and weight changes (17%), desire for pregnancy (13%), or heavy menstrual bleeding (9%).
Awareness of the IUCD was reported by 37%, with only the diaphragm and male surgical sterilization having lower levels of general awareness. Very few (8%) participants reported having been informed about the IUCD previously by a medical provider, and fewer were specifically aware of the copper (4%) or levonorgestrel (3%) IUCD. IUCD awareness was significantly associated with greater age, greater numbers of prior pregnancies and living children, lower education, and lower likelihood of sexual activity or not switching contraceptive methods in the last year (). In multivariable logistic regression analysis, only increasing age (AOR = 1.15, 95%, confidence intervals, CI: 1.10–1.20) and not switching contraceptive methods in the last year (AOR = 2.45, 95% CI: 1.03–5.83) were independently associated with IUCD awareness.
Correlates of intrauterine contraceptive device (IUCD) awareness and interest in IUCD use among HIV-positive women in Cape Town, South Africa by univariable logistic regression analysis.
Following a brief information session on IUCDs, 86% (n = 206 of 240 women not having been sterilized) were potentially interested in future IUCD use. Interest in IUCD use was associated with younger age and being sexually active in the last year; marginal associations were noted with being unemployed, having a regular menstrual cycle, or having perceived menstrual irregularities in bivariate logistic regression. Of note, all women with more than one sexual partner in the last year reported interest in the IUCD (). In multivariable logistic regression, interest in IUCD use was independently inversely associated with age (AOR = 0.91, 95% CI: 0.86–0.97) and marginally with having menstrual bleeding pattern complaints (AOR = 2.14, 95% 0.98–4.68). Those interested in the IUCD were queried about the positive features of the IUCD as an open-ended question, and the common features ranking highest (of 408 total responses, multiple responses were allowed) were duration of action (42%), reversible method/rapid restoration of fertility (33%), efficacy at preventing pregnancy (12%), and ease of insertion/removal (10%). Based on potential menstrual changes, particularly with the levonorgestrel IUCD, willingness to use the IUCD with accompanying menstrual changes was queried. Nearly all interested participants (n = 204) desired the IUCD if oligo/amenorrhea resulted, while only 8 were willing to use an IUCD if menstrual bleeding increased. Many (60%, n = 143) believed their partner would be receptive to the IUCD.