Does integrating family planning into HIV care and treatment impact intention to use contraception? Patient perspectives from HIV‐infected individuals in Nyanza Province, Kenya

Abstract

Objective To evaluate whether HIV-infected women and men in HIV care and not using highly effective methods of contraception thought they would be more likely to use contraception if it were available at the HIV clinic. Methods A face-to-face survey assessing family-planning knowledge, attitudes, and practices was conducted among 976 HIV-infected women and men at 18 public-sector HIV clinics in Nyanza, Kenya. Data were analyzed using logistic regression and generalized estimating equations. Results The majority of women (73%) and men (71%) thought that they or their partner would be more likely to use family planning if it were offered at the HIV clinic. In multivariable analysis, women who reported making family-planning decisions with their partner (adjusted odds ratio [aOR] 3.22; 95% confidence interval [CI], 1.53–6.80) and women aged 18–25 years who were not currently using family planning (aOR 4.76; 95% CI, 2.28–9.95) were more likely to think they would use contraception if integrated services were available. Women who perceived themselves to be infertile (aOR 0.07; 95% CI, 0.02–0.31) and had access to a cell phone (aOR 0.40; 95% CI, 0.25–0.63) were less likely to think that integrated services would change their contraceptive use. Men who were not taking antiretroviral medications (aOR 3.30; 95% CI, 1.49–7.29) were more likely, and men who were unsure of their partner’s desired number of children (aOR 0.36; 95% CI, 0.17–0.76), were not currently using family planning (aOR 0.40; 95% CI, 0.22–0.73), and were living in a peri-urban setting (aOR 0.46; 95% CI, 0.21–0.99) were less likely to think their partner would use contraception if available at the HIV clinic. Conclusions Integrating family planning into HIV care would probably have a broad impact on the majority of women and men accessing HIV care and treatment. Integrated services would offer the opportunity to involve men more actively in the contraceptive decision-making process, potentially addressing 2 barriers to family planning: access to contraception and partner uncertainty or opposition.

Reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome

“…The predominance of age lower than 39 years, steady relationship, and low household income among the study participants showed that women of reproductive age and socio-economic vulnerability were exposed to the virus through sexual transmission, in conformity with other studies (4,(12)(13) . According to the current research, after diagnosis women with HIV/AIDS continued working actively to guarantee the income of their children and partners (14) .…”

“…It should be mentioned that these same clinical characteristics were also found among African women (14)(15) . Considering that the discovery of infection among the current study participants took place during a prenatal examination, more than half of the women with HIV/ AIDS already had one or two children at the time of the interview, a number similar to that found in other studies (10,(13)(14) . Evidence shows that maternity is an important motivation for women with HIV/AIDS to continue with their life plans and adhere to the treatment (15) .…”

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

“…This was a similar finding among men at the non-integrated sites in the CRT as well. 15 The men strongly identified with their HIV care clinic and its providers over the MCH clinics. Integration of FP and HIV services is occurring at several types of facilities in SSA, not just at HIV care clinics.…”

“…The unmet need for FP services is particularly high in Kenya; one study found that nearly 70% of HIV-positive women in western Kenya indicate wishing to delay their fertility for another 2 years or not have any further children. 15 Yet, among this same population, only 19% of the women reported the use of more effective contraception (defined as hormonal methods, intrauterine devices (IUDs), and permanent methods). 16 Two systematic reviews have now demonstrated that integrating FP and HIV services is feasible and has varying degrees of positive health outcomes.…”

“…26 A baseline survey for the above CRT found that 75% of HIVpositive women in HIV care reported making FP decisions jointly with their partner. 15 A study of pregnant women in western Kenya found that women who indicated having discussed their FP intentions with their male partners and perceiving their partner's approval were two of the strongest factors associated with contraceptive use intentions. 27 Furthermore, men do prefer being involved in FP decisionmaking with their partners.…”