Neglect of Attention to Reproductive Health in Women With HIV Infection

Contraceptive Use and Unintended Pregnancies in the Swiss HIV Cohort Study

K Aebi-Popp; V Mercanti; C Voide; J Nemeth; A Cusini; B Jakopp; D Nicca; M Rasi; A Bruno; A Calmy; B Martinez de Tejada


HIV Medicine. 2018;19(5):339-346. 

In This Article


Study Design and Population

We conducted a cross–sectional multicentre survey nested in the SHCS. We identified all women from the SHCS database who were born between 1967 and 1994 (18 to 46 years old) and had at least one follow–up visit after January 2012. These women were invited to participate in the study during their clinical follow–up routine visit. The anonymous, self–administered questionnaire aimed to obtain information about current and past contraceptive methods used by each woman, and about unintended pregnancies. Pregnant women were excluded. The questionnaire was available in four languages (English, French, German and Italian) (Appendix S1). The ethics committees of all participating institutions approved the SHCS protocol and all participants provided written informed consent.

Variables and Measurement

The following data were collected: current type and name of contraception; duration of current contraception; current contraceptive adherence; reason for condom use (if applicable); previous contraception; number of unintended pregnancies during contraceptive use; contraception method used when the unintended pregnancy occurred, and whether the pregnancy was terminated or not. Contraceptive methods were grouped as follows: hormonal contraception, including the combined and progestin–only pills, vaginal ring, transdermal patch, injectables, hormonal implant and hormonal IUD; mechanical contraception, such as the male latex condom and copper IUD; and other contraceptive methods, including withdrawal, calendar–based methods, cervical mucus– or basal body temperature–based methods, use of spermicides, tubal sterilization and vasectomy.

We collected the following sociodemographic characteristics from the SHCS database: ethnicity; age; height; weight; body mass index; date of first positive HIV test; source of infection; educational level; cardiovascular risk, including current smoker status and hypertension (treatment for hypertension and/or systolic blood pressure > 160/100 mmHg and diastolic blood pressure > 100 mmHg); relationship status during the last 6 months (no sexual partners, occasional sexual partners or stable partnership); HIV RNA and CD4 cell count at last visit; and coinfection with any hepatitis virus. The route of HIV acquisition was categorized as heterosexual, injecting drug use, and other routes, such as infection perinatally or via transfusion. We categorized the level of education as high (university bachelor's degree or higher professional education qualification) and middle/low (apprenticeship/mandatory school or no completed schooling). ART was classified into five groups: no current treatment or naïve at survey time and at the time of unintended pregnancy; regimens based on a boosted protease inhibitor (PI) with nucleoside reverse transcriptase inhibitors; EFV–based regimens; NVP–based regimens; and other combinations of ART.

Statistical Analysis

Quantitative variables were summarized as medians and interquartile ranges and qualitative variables as frequencies and percentages for the entire population and for each ART subgroup. Proportions and 95% confidence intervals (CIs) for the total population and for each ART subgroup were calculated. Univariable comparisons were carried out with the χ 2 test for categorical variables and the Wilcoxon rank sum test for continuous variables. Sociodemographic and behavioural characteristics associated with having an unplanned pregnancy in univariable analyses (P < 0.1) were included in the multivariable model. Risk factors for the occurrence of an unplanned pregnancy were analysed by multivariate logistic regression models adjusted for age, type of ART and HIV status. All statistical analyses were performed using stata version 13.0 (Stata Corp, College Station, TX).