Factors Influencing Contraceptive Choice and Discontinuation among HIV-Positive women in Kericho, Kenya
Abstract
This study explored perceptions towards and utilization of contraception among HIV-positive, reproduction-age women in Kericho, Kenya, an area with high HIV and low contraceptive prevalence rates. Qualitative methods were used in three focus group discussions and 15 in-depth interviews to gather data from 46 HIV-positive women ages 18 to 45, purposively selected by age strata. Analysis was performed using ATLAS-ti (ATLAS-ti Center, Berlin). Most participants reported familiarity with modern contraceptives. Participants generally perceived that men opposed contraception. Some women indicated that their HIV status dictated contraceptive decisions, particularly with regard to abstinence. Women reported method discontinuation because of side effects, having met desired parity, and menstrual changes. Findings suggested that perceptions about side effects, opinions of the male partner, and HIV disease progression play important roles in contraceptive decisions. Counseling can dispel incorrect information and optimize contraceptive practice in this setting (Afr J Reprod Health 2010; 14[4]: 103-114).
Résumé
Facteurs qui influent sur le choix et l’interruption du contraceptif chez les femmes séropositives à Kericho, Kenya. Cette étude a exploré les perceptions envers l’utilisation de la contraception chez les femmes séropositives qui sont en âge de procréer, à Kericho, une région qui a un taux élevé de prévalence du VIH et un taux bas de prévalence contraceptive. On s’est servi des méthodes qualitatives dans trois discussions à groupe cible et 15 interviews en profondeur pour collecter des données des 46 femmes séropositives âgées de 18 à 45 ans sélectionnées de manière calculée d’après l’âge. L’analyse a été faite à l’aide d’ATLA-ti (Centre d »ATLAS-ti, Berlin). La plupart des participants ont indiqué une familiarité avec les contraceptifs modernes. Les participants ont en général aperçu que les hommes se sont opposés à la contraception. Certaines femmes ont indiqué que leur état séropositif a dicté les décisions contraceptives, surtout à l’égard de l’abstinence. Les femmes ont signalé l’interruption des méthodes à cause des effets secondaires, ayant satisfait la parité désirée et des modifications menstruelles Les résultats ont suggéré que les perceptions par rapport aux effets secondaires, les opinions du partenaire male et la progression de la maladie du VIH jouent des rôles dans les décisions contraceptives. L’assistance socio-psychologique peut dissiper l’information incorrecte et optimiser la pratique contraceptive dans ce milieu (Afr J Reprod Health 2010; 14[4]: 103-114).
Keywords: Contraception, fertility intentions, HIV, antiretroviral therapy, Kenya, qualitative methods
Full Text:
PDFReferences
Johnson KB, Akwara P, Rutstein SO, Bernstein S. Fertility preferences and the need for contraception among women living with HIV: the basis for a joint action agenda. AIDS 2009; 23 (Suppl 1):S7-S17.
Myer L, Akugizibwe P. Impact of HIV treatment scale-up on women’s reproductive health care and reproductive rights in Southern Africa. J Acquir Immune Defic Syndr 2009; 52 (Suppl 1):S52-3.
Keogh SC, Urassa M, Kumogola Y, Mngara J, Zaba B. Reproductive behaviour and HIV status of antenatal clients in northern Tanzania: opportunities for family planning and preventing mother-to-child transmission integration. AIDS 2009; 23 (Suppl 1):S27-35.
Stuart GS. Fourteen million women with limited options: HIV/AIDS and highly effective reversible contraception in sub-Saharan Africa. Contraception 2009; 80 (5):4126.
Laher F, Todd CS, Stibich MA, Phofa R, Behane X, Mohapi L, Gray G. A qualitative assessment of decisions affecting contraceptive utilization and fertility intentions among HIV-positive women in Soweto, South Africa. AIDS Behav 2009; 13 (Suppl 1):47-54.
Hoffman IF, Martinson FE, Powers KA, Chilongozi DA, Msiska ED, Kachipapa EI, Mphande CD, Hosseinipour MC, Chanza HC, Stephenson R, Tsui AO. The yearlong effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. J Acquir Immune Defic Syndr 2008; 47(4):477-83.
Taulo F, Berry M, Tsui A, Makanani B, Kafulafula G, Li Q, Nkhoma C, Kumwenda JJ, Kumwenda N, Taha TE. Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS Behav 2009; 13 (Suppl 1):20-7.
Homsy J, Bunnell R, Moore D, King R, Malamba S, Nakityo R, Glidden D, Tappero J, Mermin J. Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS ONE 2009; 4(1):e4149.
Gillespie D, Bradley H, Woldegiorgis M, Kidanu A, Karklins S. Integrating family planning into Ethiopian voluntary testing and counselling programmes. Bull World Health Organ 2009; 87(11):866-70.
Ngure K, Heffron R, Mugo N, Irungu E, Celum C, Baeten JM. Successful increase in contraceptive uptake among Kenyan HIV-1-serodiscordant couples enrolled in an HIV-1 prevention trial. AIDS 2009;23 (Suppl 1):S89-95.
Brou H, Viho I, Djohan G, Ekouévi DK, Zanou B, Leroy V, Desgrées-du-Loû A; pour le groupe Ditrame Plus ANRS 1202/1201/1253. Contraceptive use and incidence of pregnancy among women after HIV testing in Abidjan, Ivory Coast. Rev Epidemiol Sante Publique 2009;57(2):77-86.
Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav 2009;13 (Suppl 1):38-46.
Grabbe K, Stephenson R, Vwalika B, Ahmed Y, Vwalika C, Chomba E, Karita E, Kayitenkore K, Tichacek A, Allen S. Knowledge, use, and concerns about contraceptive methods among sero-discordant couples in Rwanda and Zambia. J Women’s Health (Larchmt) 2009; 18(9):1449-56.
Wilcher R, Cates W Jr, Gregson S. Family planning and HIV: strange bedfellows no longer. AIDS 2009; 23 (Suppl 1):S1-6.
Gruskin S, Firestone R, Maccarthy S, Ferguson L. HIV and pregnancy intentions: do services adequately respond to women’s needs? Am J Public Health 2008;
(10):1746-50.
Rutenberg N, Baek C. Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV. Stud Fam Plann 2005; 36(3):23545.
Joint United Nations Program on HIV/AIDS (UNAIDS). Report on the Global AIDS Epidemic. Geneva: UNAIDS; 2008.
Kenya National AIDS and STI Control Program (NASCOP), Kenya National AIDS Control Council (NACC), Kenya National Bureau of Statistics (KNBS), National Public
Health Laboratory Services (NPHLS), Kenya Medical
Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD). Kenya AIDS Indicator Survey 2007. Ministry of Public Health & Sanitation, Republic of Kenya. Nairobi, Kenya, 2009.
Analysis, Information Management and Communication Activity (AIM) Project. USAID Country Health Statistical Report: Kenya. USAID. Washington, D.C., 2009.
Yin S, Kent M. Kenya: The demographics of a country in turmoil. The Population Reference Bureau. Available at: http://www.prb.org/Articles/2008/kenya.aspx. Accessed March 30, 2010.
Anand A, Shiraishi RW, Bunnell RE, Jacobs K, Solehdin N, Abdul-Quader AS, Marum LH, Muttunga JN, Kamoto K, Aberle-Grasse JM, Diaz T. Knowledge of HIV status, sexual risk behaviors and contraceptive need among people living with HIV in Kenya and Malawi. AIDS 2009; 23(12): 1565-73.
Mutiso SM, Kinuthia J, Qureshi Z. Contraceptive use among HIV infected women attending Comprehensive Care Centre. East Afr Med J 2008; 85(4): 171-7.
Bii SC, Otieno-Nyunya B, Siika A, Rotich JK. Family planning and safer sex practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital. East Afr Med J 2008; 85(1): 46-50.
Okal J, Stadler J, Ombidi W, Jao I, Luchters S, Temmerman M, Chersich MF. Secrecy, disclosure and accidental discovery: perspectives of diaphragm users in Mombasa, Kenya. Cult Health Sex 2008; 10(1):13-26.
Balkus J, Bosire R, John-Stewart G, Mbori-Ngacha D, Schiff MA, Wamalwa D, Gichuhi C, Obimbo E, Wariua G, Farquhar C. High uptake of postpartum hormonal contraception among HIV-1-seropositive women in Kenya. Sex Transm Dis 2007; 34(1):25-9.
Sateren WB, Foglia G, Renzullo PO, et al. Epidemiology of HIV-1 infection in agricultural plantation residents in Kericho, Kenya: preparation for vaccine feasibility studies. J Acquir Immune Defic Syndr 2006; 43(1):1026.
Foglia G, Sateren WB, Renzullo PO, Bautista CT, Langat L, Wasunna MK, Singer DE, Scott PT, Robb ML, Birx DL. High prevalence of HIV infection among rural tea plantation residents in Kericho, Kenya. Epidemiol Infect 2008; 136(5):694-702.
Kenya Central Bureau of Statistics. 2003 Demographic and Health Survey. Nairobi, Kenya: Department of Health; 2003.
U.S. Army Medical Research Unit—Kenya: The Walter Reed Project. Available at: http://www.usamrukenya. org/hiv.htm. Accessed October 3, 2010.
Bernard, H.R. (2001) Unstructured and semi-structured interviewing. In: Bernard HR. Research Methods in Anthropology: Qualitative and Quantitative Approaches. Walnut Creek, CA: AltaMira Press, 2001, 208-236.
Glaser, B. Basics of Grounded Theory Analysis. Mill Valley, California: Sociology Press, 1992.
Elul B, Delvaux T, Munyana E, Lahuerta M, Horowitz D, Ndagije F, Roberfroid D, Mugisha V, Nash D, Asiimwe A. Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda. AIDS 2009;23 (Suppl 1):S19-26.
Feldman R, Maposhere C. Safer sex and reproductive choice: findings from “positive women: voices and choices” in Zimbabwe. Reprod Health Matters 2003;11(22):162-73.
Malta MS, Todd CS, Stibich MA, Garcia T, Pacheco D, Bastos FI. Factors influencing contraceptive choice and discontinuation among HIV-positive women in Rio De Janeiro, Brazil. Abstract# 502. Oral presentation, International Conference on Family Planning: Research and Best Practices, Kampala, Uganda, November 15-18, 2009.
Laher F, Todd CS, Stibich MA, Phofa R, Behane X, Mohapi L, Martinson N, Gray G. Role of menstruation in contraceptive choice among HIV-infected women in Soweto, South Africa. Contraception 2010; 81(6):54751.
Bradley SEK, Schwandt HM, Khan S. Levels, trends, and reasons for contraceptive discontinuation. DHS Analytical Studies 2009; no. 20. Calverton, Maryland, USA: ICF Macro.
Stringer EM, Kaseba C, Levy J, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol 2007; 197(2):144.e1-8.
Mark KE, Meinzen-Derr J, Stephenson R, Haworth A, Ahmed Y, Duncan D, Westfall A, Allen S.
Contraception among HIV concordant and discordant couples in Zambia: a randomized controlled trial. J Women’s Health (Larchmt) 2007;16 (8):1200-10.
Shaffer DN, Ngetich IK, Bautista CT, Sawe FK, Renzullo PO, Scott PT, Kibaya RM, Imbuki KO, Michael NL, Birx DL, Wasunna MK, Robb ML. HIV-1 incidence rates and risk factors in agricultural workers and dependents in rural Kenya: 36-month follow-up of the Kericho HIV cohort study. J Acquir Immune Defic Syndr 2010; 53(4):514-21.
Malungo JR. Sexual cleansing (Kusalazya) and levirate marriage (Kunjilila mung'anda) in the era of AIDS: changes in perceptions and practices in Zambia. Soc Sci Med 2001; 53(3):371-82.
Ounga T, Okinyi M, Onyuro S, Correa M, Gisselquist D. Exploratory study of blood exposures that are risks for HIV among Luo and Kisii ethnic groups in Nyanza province, Kenya. Int J Std AIDS 2009; 20(1):19-23.
Refbacks
- There are currently no refbacks.