Oral contraception and unprotected sex with occasional partners of women HIV-infected through injection drug use

Abstract

Among HIV-infected women, unprotected sex with the main sexual partner is common practice. Conversely, studies about condom use with sexual partners of unknown HIV sero-status are sparsely reported. We aimed to assess the impact of oral contraception on unsafe sexual behaviours with occasional partners in women HIV-infected through injection drug use. The analysis focused on 90 women, enrolled in the French cohort MANIF 2000 and reported having engaged in sexual relationships with occasional partners during a 48-month period. Visits where women reported unprotected sex with occasional partners in the prior 6 months were compared to visits where they reported protected sex using a logistic model based on Generalised Estimating Equations. Unprotected sex with occasional partners was independently associated with oral contraception (OR[95%CI] = 3.2[1.4-7.2]), reporting only one occasional partner (OR[95%CI] = 3.1[1.6-6.2]) and antiretroviral treatment receipt. No significant association was found between unprotected sex and CD4 level or plasma viral load. With the growing population of people living with HIV as a chronic infection, the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Risk reduction counselling and interventions are needed to promote either the use of dual contraception or, alternatively, that of female condom.

Contraceptive Methods and Risk of HIV Acquisition or Female-to-Male Transmission

“…These reports highlight the importance of access to health care [104, 105], reporting women's concerns about contraceptive side effects [108] or potential interactions with ARVs [108], convenience of barrier contraceptive methods [104, 105, 111], and desire to have children [107–109] as determinants of contraceptive method use in women living with HIV [104]. Additionally, contraceptive use may differ by partner type; for instance, among a cohort of French women living with HIV, contraceptive use was more prevalent among women reporting recent sexual encounters with casual partners [112]. …”

HIV Infection and Contraception

“…Condom usage requires cooperation from the male partner and, for women, there is a justifiable fear of suggesting condom use because it might result in partner suspicion about serostatus and/or violence. Also, there is the difficulty of negotiating safer sex practices, especially with occasional partners (Carrieri et al, 2006). Condom use is often a point of contention between partners (Gogna, Pecheny, Ibarlucia, Manzelli, & Lopez, 2009).…”

“…In addition, concurrent condom use is essential because evidence suggests that hormonal contraception methods might have decreased effectiveness in the context of ART (''Contraception safe for HIVpositive women,'' 2009). There is some evidence that starting ART increases unsafe sexual behaviors in HIV-infected women (Carrieri et al, 2006). Dual use contraception should be promoted in both HIVinfected and uninfected people.…”

Behavioral risk assessment for infectious diseases (BRAID): Self-report instrument to assess injection and noninjection risk behaviors in substance users

“…These include noninjection risks such as sharing intranasal drug use equipment (Koblin et al, 2003) and binge drug use (Miller et al, 2006), and injection behaviors that incur heightened risk, such as transitioning between noninjection and injection drug use (Griffiths et al, 1992; Strang et al, 1992; Griffiths et al, 1994; Darke et al, 1994a, 1994b; Crofts et al, 1996; Irwin et al, 1996; Fuller et al, 2002; Abelson et al, 2006), assisting someone with injections or being a new intravenous drug user (Hagan et al, 2001; Vidal-Trecan et al, 2002; Wood et al, 2003; Roy et al, 2004; O’Connell et al, 2005; Fairbairn et al, 2006), and being a former but not current intravenous drug user (Friedman et al, 1995; Neaigus et al, 2001b). Additional sexual risk behaviors have also been identified, including the frequency of anal and vaginal sexual intercourse and whether the act was insertive or receptive (Benotsch et al, 1999; Hoffman et al, 2000), sex with other drug users (Neaigus et al, 2001a; Bravo et al, 2003; Roy et al, 2004; Purcell et al, 2006), having sex while under the influence of drugs (Celentano et al, 2006), having sex for an extended duration of time (Semple et al, 2009), having a lifetime history of a sexually transmitted disease (Hwang et al, 2000; Kalichman et al, 2005), and being sexually active following an HIV diagnosis (Campsmith et al, 2000; Aidala et al, 2006; Carrieri et al, 2006; Niccolai et al, 2006; Brewer et al, 2007). Finally, risks specific to the drug class being abused, including alcohol (Fitterling et al, 1993; Rasch et al, 2000; Stein et al, 2000; Rees et al, 2001; Kalichman et al, 2005; Raj et al, 2006), stimulants (Booth et al, 2000; Logan and Leukefeld, 2000; McCoy et al, 2004; Edwards et al, 2006; Volkow et al, 2007), and opioids (Sanchez et al, 2002; El-Bassel et al, 2003; Conrad et al, 2015) have also been associated with increased disease risk.…”