Original articles

Messages about dual contraception in areas of high HIV prevalence are not heeded

Nokuthula Ngubane, Deven Patel, Marie-Louise Newell, Hoosen M Coovadia, Nigel Rollins, Anna Coutsoudis, Ruth Margaret Bland

Abstract


Background:
Dual protection is recommended for prevention of unwanted pregnancies and protection against sexually transmitted infections, including HIV. It is critical for HIV-negative women to prevent sero-conversion and HIV transmission to their infants during pregnancy and breastfeeding.

Methods:
Women were followed post-partum, monthly to 9 months and 3-monthly to 24 months, in a cohort study investigating postnatal HIV transmission. Study nurses discussed family planning, including condom use, at each visit. Contraceptive methods used since the last visit were recorded. All women knew their HIV status; most women breastfed for a minimum of six months.

Results:
Of 1137 HIV-positive and 1220 HIV-negative women the most common contraceptive method was the hormonal injectable; few women used condoms alone or as dual contraception (0-3 months 6.8%; 7-12 months 16.3%; 19-24 months 14.4%). HIV-positive women were more likely to use condoms in years one and two post-partum (AOR 1.72, 95%CI 1.38-2.14, p<0.001; AOR 1.61, 95%CI 1.15-2.25, p=0.006 respectively). Compared to women with a flush toilet, those with a pit latrine were less likely to use condoms in years one and two (AOR 0.22, 95%CI 01.7-0.28, p<0.001; AOR 0.27, 95%CI 0.19-0.39, p<0.001). Older women were more likely to use condoms in the first year post-partum (AOR 1.78, 95%CI 1.03-3.09, p=0.040).

Conclusions:
More creative ways of promoting condoms and dual contraception need to be found if new HIV infections, in women and children, are to be prevented.

Authors' affiliations

Nokuthula Ngubane, Africa Centre for Health and Population Studies, University of KwaZulu Natal

Deven Patel, Institute of Child Health, University College London

Marie-Louise Newell, Africa Centre for Health and Population Studies, University of KwaZulu Natal

Hoosen M Coovadia, Centre for HIV/AIDS Networking, University of KwaZulu Natal

Nigel Rollins, Dept of Paediatrics and Child Health, University of KwaZulu Natal

Anna Coutsoudis, Dept of Paediatrics and Child Health

Ruth Margaret Bland, Africa Centre for Health and Population Studies, University of KwaZulu Natal

Full Text

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Keywords

HIV, contraception, PMTCT, rural Africa, dual contraception, condoms

Cite this article

South African Medical Journal 2008;98(3):209.

Article History

Date submitted: 2007-05-14
Date published: 2008-03-05

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