Impact of HIV infection on fertility intention and Modern contraceptives methods use among women attending Kiambu County Referral Hospital Comprehensive Care Centre
HIV has a profound effect on morbidity and mortality particularly among the affected individuals from sub-Saharan Africa. Out of the 75 % individuals now living with HIV in the region more than half of them are female. Besides, women carry a higher burden from the disease as it affects their reproductive health choices and plans. However modern contraceptive methods if used effectively can prevent Mother to Child HIV transmission, unintended pregnancies and maternal mortality. The aim of this study was to evaluate the impact of HIV infection on fertility intention and modern contraceptive use amongst women living with HIV. A survey was conducted at Comprehensive Care Centre Kiambu County Referral. Data collection methods includes interviews using structured questionnaires, focus group discussions and key informants interviews with selected service providers. A total of 275 participants were enrolled into the study. The median age group of the participants was (30 – 34) years with range of 15 – 49 years. 123(45%) of the participants were single while 114 (41%) of the respondents had primary level as the highest level education. 250(91%) were pregnant at the time of data collection. Most of the respondents, 153 (56%) wanted to have more children. 122(44%) did not want to have more children due to assorted reasons. Of the respondents who did not want to have more children, 70(57%) stated that they were satisfied with the number of children, 26(21%) agreed that they would not risk due to HIV, 12(10%) stated that their spouse disapproved, 10(8%) of the respondents had no spouses while 4(3%) stated that their age would not allow them to have more children. Most of the participants, 193(71%) were using a family planning method while 82 (29%) did not. Out of those who used contraception, 70(36%) used condoms. Most of the respondents 196(71%) used condoms and other contraceptive methods. Only 113 (62%) reported that their partners supported them in using contraceptives. 66% made self-decisions on the mode of family planning that they use. From the 25 respondents who were pregnant, 24(95%) were on ART while 1(4%) was not on further inquiry it was reported that the patient was not compliant with ARV’s. Majority of the respondents from the focussed groups agreed that condoms were the safest mode of contraception. In the focus groups, it was also agreed that proper advice was given on family planning methods by medical attendants at the CCC and emphasis of using condoms alongside other methods of family planning were given. 48% agreed that they received family planning services during HIV support. There was a significant association between being a member of the HIV support groups and contraceptive use. Most of the respondents got more information through support groups. Socio-demographic factors like age and marital status were found to influence the use of contraceptive methods among women LWHA. Most of them are in the peak reproductive age and they are single hence the necessity of contraception. Moreover, women’s parity was crucial since most women are not afraid of bearing children due to the availability of ART to all affected women. Partners’ role is minimal in decision making on contraception since most of the women make self-decisions. We recommend that the county health management team should emphasize on community outreach activities at the household level on HIV and family planning education to fill out the gap of those not on contraception and promotion of more HIV support groups.
2. Ministry of Health: Guidelines for PMTCT of HIV/ AIDS in Kenya 4th Edition 2012
3. Ministry of Health: Kenya HIV Estimates Nairobi: June 2014
4. Melaku, Yohannes Adama, and Ejigu Gebeye Zeleke. "Contraceptive Utilization and Associated Factors among HIV-positive Women on Chronic Follow up Care in Tigray Region, Northern Ethiopia: A Cross Sectional Study." PloS one 9.4 (2014): e94682.
5. Imbuki, Kennedy, et al. "Factors influencing contraceptive choice and discontinuation among HIV-positive women in Kericho, Kenya." African Journal of Reproductive Health 14.4 (2010)
6. Chen, James L., et al. "Fertility desires and intentions of HIV-positive men and women." Family planning perspectives (2001): 144-165.
7. AETC National Resource Centre: HIV ClassificationCDC and WHO Staging Systems, April 2014
8. Lihana, Raphael W., et al. "Update on HIV-1 diversity in Africa: a decade in review." AIDS Rev 14.2 (2012): 83-100.
9. UNAIDS: Fact sheet 2014.
10. Ministry of Health: Kenya AIDS Indicator Survey, 2012 Nairobi.
11. Ministry Of Health: Kenya HIV Estimates Technical Report 2013
12. Joint United Nations Programme on HIV/AIDS: countdown to zero HIV-PMTCT Fact sheet Kenya, 2012
13. Ministry Of Health: Kenya HIV Prevention Response and Modes of Transmission Analysis March 2009
14. United Nation Systems in Kenya: UN Kenya Newsletter Special Edition March 2014.
15. United Nations:The Millennium Development Goals Report. 2014.
16. Pullum, Thomas, John Cleland, and Iqbal Shah. "Consensus, power and trust in the use of family planning and condoms by couples in Eastern and Southern Africa." IUSSP International Conference, Tours. Vol. 18. 2005.
17. Williamson, Nancy E., et al. "A qualitative study of condom use among married couples in Kampala, Uganda." Reproductive health matters 14.28 (2006): 89-98.
18. Welbourn, Alice. "Sex, life and the female condom: some views of HIV positive women." Reproductive Health Matters 14.28 (2006): 32-40.
19. UNFPA: Annual Report 2004.
20. Walker, Dilys M., et al. "Emergency contraception use is correlated with increased condom use among adolescents: results from Mexico." Journal of Adolescent Health 35.4 (2004): 329-334.
21. Delvaux, Therese, and Christiana Nöstlinger. "Reproductive choice for women and men living with HIV: contraception, abortion and fertility." Reproductive health matters 15.29 (2007): 46-66.
24. Ministry of Health, Rwanda. Evaluation of access to and utilization of prevention of mother-to-Child transmission (PMTCT) services in Rwanda. Kigali TRAC, ICAP, EGPAF, January 2007.
25. International Planned Parenthood Federation, International Community of Women Living with HIV/AIDS. Dreams and Desires: Sexual and Reproductive Health. Experiences of Women Living with HIV London IPPF, ICW, 2005
26. KNBS: Kenya Demographic and Health survey, 2014.