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

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.