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Most of the women receiving care at the HIV clinic in Nashville were not using any form of contraception, and according to a study published in Open forum Infectious diseases.
These findings suggest that “there is a need for continued efforts to ensure access to effective contraceptive options in HIV clinics,” concluded study authors Manas Bhatt of Vanderbilt University and colleagues.
Women make up nearly a quarter of people living with HIV in the United States and make up 19% of new HIV diagnoses in 2019. Most newly diagnosed women are of reproductive age, but previous research has shown that contraceptive use among women with HIV is low and more than half of pregnancies are unintended. Unplanned pregnancy is associated with poor HIV and mental health outcomes, the researchers reported as background. What’s more, women who do not plan their pregnancies may miss out on appropriate prenatal care to prevent mother-to-child transmission of HIV.
Bhatt’s team analyzed contraceptive use among women receiving care at the Vanderbilt Comprehensive Care Center in Nashville between 1998 and 2018. The clinic provides primary and specialty care to people living with HIV, including screening for sexually transmitted infections and cervical cancer, family planning services, and prenatal care. It serves as a primary care clinic for most women.
This retrospective cohort study included 737 cisgender women aged 18 to 45 years with at least two clinic visits during the first year. Women who had previously undergone tubal ligation or hysterectomy were excluded, as were those diagnosed with breast, cervical, or ovarian cancer before entering the clinic. The majority (58%) were black, 36% white, and the median age was 31 years. Only 39% were already taking antiretroviral therapy when they started care at the clinic, and the median CD4 count was about 400. The mean follow-up was about four years.
Using medical records, the researchers examined all forms of effective contraception, including hormonal birth control pills, patches, injections, and implants; vaginal rings; intrauterine devices (IUDs); and tubal ligation. Injectable contraception and tubal ligation recommendations were available from the beginning of the study period, while intrauterine devices and hormonal implants were available from 2008. Information on condom use or rhythm methods, frequency of sex, or desire for pregnancy was not available.
When they started care at the clinic, only 47 women (6%) were using contraception—3% oral, 3% injectable, and 1% intrauterine therapy—and 164 (22%) women were pregnant. Among women who did not use contraception at baseline, 142 women (27%) started using it during follow-up, opting for injections (42% of those who started), pills (31%), tubal ligation (20%), or IUDs (6). %). During the study, 84 women (16%) became pregnant. There have been no cases of mother-to-child transmission of HIV.
Over the course of the study, the average annual proportion of time spent on any type of contraception among women who were not pregnant was 32%. Contraceptive use remained stable throughout the study period.
Younger women were more likely to use contraception and more likely to become pregnant. Women with mental health disorders were about half as likely to use contraception and almost twice as likely to get pregnant. Pregnant women were more likely to start using birth control after giving birth than those who had never been pregnant during the study. Race/ethnicity, substance use, and HIV-related measures (antiretroviral therapy use, viral load, and CD4 count) were not significantly associated with either contraceptive use or pregnancy after adjustment for other factors.
The study authors suggested that several factors may contribute to low contraceptive use among HIV-positive women, including reluctance to discuss family planning, which may reflect the fact that HIV-positive women have historically been advised to use permanent methods of contraception.
Concerns about using antiretroviral drugs and hormonal contraception together may also contribute to hesitancy among patients and providers, they added. However, Department of Health and Human Services Guidelines for HIV Treatment states that all HIV-positive women who are sexually active and do not wish to become pregnant should be offered contraception and may use all available methods after consideration of potential drug interactions.
“Women with HIV in our study had consistently low rates of contraceptive use over time with consistently low uptake [long-acting reversible contraception] and higher rates of tubal ligation,” the researchers wrote. “These findings highlight the need to improve reproductive health services in the care of women with HIV.”
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As seen on https://www.poz.com/article/women-living-hiv-may-need-better-access-contraception