Use of effective family planning methods and frequency of sex among HIV-infected and HIV-uninfected African women

Abstract

Background: Frequency of sex, contraceptive use and HIV infection are key determinants of fertility. Use of an effective family planning (EFP) method (injectable, oral, intra-uterine contraceptive device (IUCD), or Norplant) potentially eliminates women's concerns of unintended pregnancy. We report the association between EFP and frequency of sex among HIV-infected and HIV-uninfected non-pregnant African women.

Methods: Prospective fertility intentions study nested within a phase 3 randomized double-masked placebo-controlled trial (2003-2005) to treat genital tract infections in HIV-infected and HIV-uninfected non-pregnant women. Enrollment of study participants was stratified by HIV infection status. Data on demographics, family planning and sexual history were obtained at baseline and at 3, 6, 9 and 12 months. Chi square and Wilcoxon Rank-Sum tests were used to compare categorical and continuous variables, respectively. Generalized Estimating Equations method was used to estimate relative risk (RR) of frequent sex (≥ 2 acts/week) among users of different EFP methods (injectable, oral, implant or intra-uterine contraceptive device).

Results: After adjusting for age, current health status, and fertility intentions, EFP use was significantly associated with frequent sex among HIV-infected women (RR 1.32; 95% Confidence Interval [CI] 1.14-1.52); this association was not statistically significant among HIV-uninfected women (RR 1.10; 95% CI 0.96-1.24). Fertility intentions among HIV-infected, and education among HIV-uninfected womenwere independent predictors of sex frequency.

Conclusion: These data suggest that the association between EFP use and frequency of sex among women varies by HIV infection status. Service-delivery of diverse EFP methods should be integrated within HIV counseling, testing and treatment facilities.

Trial registration: Registration number NCT00140764 under the clinicaltrials.gov, first Posted: September 1, 2005, last Update Posted: August 10, 2011.

Keywords: Contraception; HIV/AIDS; Sexual behavior; Sub-Saharan Africa.

Conflict of interest statement

The protocol was approved by the College of Medicine Research and Ethics Committee (reference #P.00/01/119R), in Malawi, and the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (reference #H.34.01.05.21.A2) in the USA. Prior to study enrolment, written informed consent for study participation was obtained from all eligible research volunteers.As part of the enrolment criteria, all study participants provided written informed consent for study participation, and for data dissemination of study findings including through presentation at conferences and publications.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Study visit (0) or entry is the enrollment or baseline visit. Effective Family planning methods which were based on self-reported contraceptive use at study entry and during study follow-up include Injectable, oral, Intra-Uterine Contraceptive Device (IUCD), and Norplant and all the other family planning methods are classified as ‘other’; self-report sexual frequency assessed at each study visit, was defined as the proportion of women who self-reported 2 or more sexual encounters per week. HIV-infection status was based on HIV test results at study entry (enrollment)