Previous reproductive history and post-natal family planning among HIV-infected women in Ukraine

Abstract

BACKGROUNDUkraine has the highest antenatal HIV prevalence in Europe. The national prevention of mother-to-child transmission (MTCT) programme has reduced the MTCT rate, but less attention has been given to the prevention of unintended pregnancy among HIV-positive women. Our objectives were to describe the reproductive health, condom use and family planning (FP) practices of HIV-positive childbearing Ukrainian women and to identify factors associated with different methods of post-natal contraception.METHODSHIV-infected childbearing women, diagnosed before or during pregnancy, were enrolled prospectively in a post-natal cohort study in four regional HIV/AIDS centres in Ukraine from December 2007. Logistic regression models were used to identify factors associated with post-natal FP practices.RESULTSData were available for 371 women enrolled by March 2009; 82% (n = 303) were married or cohabiting, 27% (97 of 363) reported a current HIV-negative sexual partner and 69% were diagnosed with HIV during their most recent pregnancy. Overall, 21% (75 of 349) of women were not using contraception post-natally (of whom 80% reported no current sexual activity), 50% (174 of 349) used condoms, 20% (74 of 349) relied solely/partially on coitus interruptus and 4% used hormonal methods or intrauterine device. Among married/cohabiting women, consistent use of condoms in the previous pregnancy [AOR 1.96 (95%CI 1.06–3.62)], having an HIV-positive partner [AOR 0.42 (0.20–0.87)], current sexual activity [AOR 4.53 (1.19–17.3)] and study site were significantly associated with post-natal condom use; 16% of those with HIV-negative partners did not use condoms. Risk factors for non-use of FP were lack of affordability [AOR 6.34 (1.73–23.2)] and inconsistent use of condoms in the previous pregnancy [AOR 7.25 (1.41–37.2)].CONCLUSIONSMore than 40% of HIV-positive women in this population are at risk of unintended pregnancy and the one in six women in HIV-discordant couples not using barrier methods risk transmitting HIV to their partners. Our study results are limited by the observational nature of the data and the potential for both measured and unmeasured confounding.

Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011

“…However, among SSA women, the rates of contraceptive use are high compared to the observed rates in their country of birth [23], suggesting a rapid acculturation after migration to local contraception patterns. Consistent with previous studies across a range of countries [24][25][26][27][28], the distribution of contraceptive methods differs markedly among HIV-positive women compared to the general population, with a large predominance of condom use among HIV-positive women and a very low rate of use of highly effective methods, including either oral hormonal contraception or the IUD. The proportion of women reporting both HEC and condom as a contraception method was small and in the same range as reported in other western countries: 8.8% in the VESPA2 study, 12% in a convenience sample of European women [12] and 16% of adolescent and young HIV-positive women in the United States [29].…”

Postnatal contraceptive choices among women living with HIV: a decade of experience in a community-based integrated sexual health clinic

“…The Ukraine Post Natal Cohort Study of HIV-Infection Childbearing Women was established in 2007 11. Data reported in 2010 among the cohort of 371 women estimated that 21% of this group were not using contraception in the postnatal period, which is similar to the present population group.…”

High prevalence of herpes simplex virus (HSV)- type 2 co-infection among HIV-positive women in Ukraine, but no increased HIV mother-to-child transmission risk

“…In our adjusted analyses we found that HSV-2 seropositive women were more likely to have a history of pregnancy termination, which may be a marker of greater sexual risk, including lack of or inconsistent use of barrier contraception. In this population, condoms are the main form of contraception [ 23 ] which is an ineffective family planning method and of only moderate effectiveness in preventing acquisition of HSV-2 [ 24 ]. Other factors associated with significantly greater probability of HSV-2 seropositivity were having a known HIV-positive partner and being co-infected with HCV.…”