Contraceptive Choice and Use of Dual Protection Among Women Living with HIV in Canada: Priorities for Integrated Care

Kaida, Angela; Patterson, Sophie; Carter, Allison; Loutfy, Mona; Ding, Erin; Sereda, Paul; Webster, Kath; Pick, Neora; Kestler, Mary; Pokomandy, Alexandra de

doi:10.1363/psrh.12046

Cited by 13 publications

(14 citation statements)

References 73 publications

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“…Women in these relationships may not feel empowered to decide whether and when to have children. Low uptake of long-acting and preferred contraceptive methods among women living with HIV [ 19 ] may also explain the weak association between pregnancy intentions and outcomes. Unintended pregnancies are associated with an increased likelihood of negative feelings and experiences during pregnancy and in the postpartum period [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among women living with HIV of reproductive age in Canada, 60% have never discussed their reproductive goals with a healthcare provider since being diagnosed with HIV [ 17 ]. Additionally, uptake of effective contraceptive methods among women living with HIV who report wanting to avoid pregnancy is low [ 18 ], and the range of contraceptive methods used is more narrow compared to HIV negative women [ 19 ], underscoring the need and opportunity to better understand and address the sexual and reproductive health needs of women living with HIV.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of changing pregnancy intentions among women living with HIV in Canada

et al. 2021

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Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of changing pregnancy intentions among women living with HIV in Canada

et al. 2021

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“…Also, we excluded women who were using hormonal contraception or IUD, which may exclude participants who used these products for regulation of abnormal menstruation. In our analysis of contraceptive use among women living with HIV in the CHIWOS study [29], we asked women who reported using the oral contraceptive pill, injectable hormonal contraception, and the contraceptive implant the reasons for using these methods. Women could report more than one reason.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of abnormal menstruation among women living with HIV in Canada

et al. 2019

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ObjectivesTo measure the prevalence and correlates of abnormal menstruation among women living with HIV (WLWH) in Canada.MethodsWe used cross-sectional questionnaire data from the community-based Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), which enrolled WLWH aged ≥16 from British Columbia (BC), Ontario, and Quebec. For this analysis, we excluded women >45 years, who had primary amenorrhea, were pregnant, on hormonal contraception, or who reported history of endometrial cancer, last menstrual period >12 months ago, or premature ovarian failure. The primary outcome was abnormal menstruation (Yes vs No) based on responses to five questions about menstrual regularity, frequency, volume, duration, and intermenstrual bleeding in the six months prior to interview. An exploratory multivariable logistic regression analysis examined independent correlates of abnormal menstruation.ResultsOf 1422 women enrolled, 521 (37%) met eligibility criteria. Overall, 55.9% (95% CI:52%-60%) reported abnormal menstruation. In adjusted analyses, abnormal menstruation was associated with having a biologic sister/mother who entered menopause before age 40 (AOR 5.01, 95%CI 1.39–18.03), Hepatitis B co-infection (AOR 6.97, 95%CI 1.52–31.88), current smoking (AOR 1.69, 95%CI 1.55–3.41); and currently taking antiretroviral therapy (ART) (AOR 2.36, 95%CI 1.25–4.45) compared to being ART-naïve. Women in BC had higher adjusted odds of abnormal menstruation (AOR 2.95, 95%CI 1.61–5.39), relative to women in Ontario and Quebec.ConclusionsOver half of WLWH in this analysis had abnormal menstruation. Correlates of abnormal menstruation include genetic, socio-behavioural factors (province of residence, smoking), Hepatitis B co-infection, and current ART use.

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“…19 Less than 20% of women living with HIV in Canada practise WHO-defined dual protection, and 40% practised an expanded definition of dual protection (long-acting, reversible contraception plus either condoms or a suppressed HIV viral load). 17 The range of contraceptive methods used by women living with HIV is also more limited compared to women in the general Canadian population. 17 Among women living with HIV, studies suggest that awareness about safer conception methods 20 , 21 and the prevalence of receiving pre-conception counselling are low.…”

Section: Introductionmentioning

confidence: 99%

“… 17 The range of contraceptive methods used by women living with HIV is also more limited compared to women in the general Canadian population. 17 Among women living with HIV, studies suggest that awareness about safer conception methods 20 , 21 and the prevalence of receiving pre-conception counselling are low. 21 …”

Section: Introductionmentioning

confidence: 99%

Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort

Skerritt

Pokomandy

O’Brien

et al. 2021

Sexual and Reproductive Health Matters

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Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider’s gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) (2013–2017), a community-based participatory study, restricting the analysis to participants aged 16–45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one’s HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women’s comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.

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Contraceptive Choice and Use of Dual Protection Among Women Living with HIV in Canada: Priorities for Integrated Care

Abstract: Future research should explore how sustained ART and broader contraceptive options can support women's sexual and reproductive health care needs.

Cited by 13 publications

References 73 publications

Patterns of changing pregnancy intentions among women living with HIV in Canada

Patterns of changing pregnancy intentions among women living with HIV in Canada

High prevalence of abnormal menstruation among women living with HIV in Canada

Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort

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