AEGiS-15IAC: The impact of antiretroviral therapy on condom and contraceptive use among women enrolled in HIV primary care in resource-limited settings.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

The impact of antiretroviral therapy on condom and contraceptive use among women enrolled in HIV primary care in resource-limited settings.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrD1089)

Myer L, Thompson A, Rabkin M, Abrams EJ, El-Sadr WM
MTCT-Plus Initiative, Mailman School of Public Health, Columbia University, New York, United States

BACKGROUND: There are few data on the determinants of condom and contraceptive use among HIV-infected individuals in resource-limited settings, and how antiretroviral therapy (ART) effects these behaviors is unclear. We evaluated condom and contraceptive use among women in the MTCT-Plus Initiative, a multi-country HIV primary care program focused on women receiving pMTCT interventions as an entry point into family-based HIV care including ART.

METHODS: 1018 women were enrolled between February and November 2003 at 16 sites across Africa and Thailand (this analysis excludes children and male partners enrolled in the program). Patients reported on condom and contraceptive use at enrollment and at each follow-up visit. Generalized estimating equation models were used to account for the clustering of individuals within sites and repeated measures through time.

RESULTS: At enrollment, most nonpregnant women (n=610) were WHO stage I (60%, n=364), 2% (n=13) were on ART, 28% (n=171) reported condom use and 36% (n=222) reported use of a non-barrier contraceptive method (mainly injectable methods, n=114). Condom use at enrollment was independently associated with earlier HIV disease stage (p=0.05) and disclosure of HIV status (p=0.02). Use of non-barrier contraceptive methods was significantly associated with advanced HIV disease stage (p=0.04) and non-disclosure of HIV status (p=0.03). At follow-up, condom use was associated with increasing education, HIV disclosure, and initiation of ART (adjusted odds ratio: 1.42; 95% CI: 1.05-1.93). Use of non-barrier methods at follow-up was associated with advanced disease (p=0.01), but not with ART (p=0.24).

CONCLUSIONS: ART initiation was associated with increased condom use but not with use of non-barrier contraception, contradicting the hypothesis that ART initiation may be associated with increased high-risk sexual behaviours. These findings emphasize the importance of promoting condom use and reproductive choice in HIV primary care regardless of ART use.

Keywords: AEGIS, Condoms, HIV Seropositivity, Acquired Immunodeficiency Syndrome, HIV Infections, Contraceptive Agents, Contraception, Sexual Behavior, Safe Sex, Spermatocidal Agents, Thailand, Africa, Humans, Female, Child, Male, therapy, utilization

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