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


Population Characteristics and Sexual Partnership

Overall, we contacted 520 women during their routine cohort follow–up visit in an HIV medical clinic between November 2013 and June 2014 and asked them to fill out the questionnaire. Fifty–eight women did not participate in this study (23 were pregnant, 20 refused to participate and 15 did not complete the questionnaire). The sociodemographic characteristics of the 462 (83.1%) women who completed the questionnaire are described in Table 1. The most frequent mode of HIV acquisition was heterosexual intercourse (86.6%; 382 of 462) and the most frequent ethnicity was black African origin (44.4%). Median time since HIV diagnosis was 10 years (interquartile range 6–15 years). Most women were on cART (93.7%) and the most frequently used regimen was based on a boosted PI (64.5%; 298 of 462). At the time of study inclusion, most women had an undetectable HIV RNA viral load (88.6%). Seventy–three (15.8%) women had a body mass index ≥ 30, 142 (30.7%) were smokers, and 36 (7.9%) had hypertension. Among the recruited women, 332 (72%) were in a stable sexual relationship and eight reported both stable and occasional sexual partners. Twenty–one (4.5%) reported having only occasional sexual partners and 101 (21.9%) reported no sexual relationships. Of 29 ART–naïve women, 24 reported being in a stable partnership.

Women Using Contraceptives

Most of the 298 women (64.5%) on contraception mentioned the use of at least one method, but only one–quarter (25.2%; 75 of 298) used methods other than male latex condoms (Table 2). Thirty–two women were taking a hormonal oral pill, 17 had a hormonal IUD, 11 had a copper IUD, six had a hormonal implant, five used injectables, two used a vaginal ring, and one used a contraceptive patch. Among all women on contraception, 32 (10.7%) used two (30 women) or three (two women) types of contraceptive. If a dual method was used, it was based on male condoms plus oral contraception (12 women), a hormonal IUD (eight), tubal sterilization (seven), a copper IUD (two), a vaginal ring (one), or other methods (two). The rate of dual contraception use was higher in treatment–naïve women than in those on cART (21.7% vs. 9.8%, respectively; P = 0.076) (Table 2).

Most condom users (73.5%) reported consistent use (at each vaginal intercourse) over the past 2 years. For 19 of 219 (8.8%) women, the reason for condom use was to prevent pregnancy alone. However, the majority (68%) reported that it was for both protection from sexually transmitted diseases and avoidance of pregnancy (Table 2). Among treatment–naïve women, 78% used male condoms, which was slightly higher than in those on ART (70%). A hormonal type of contraception was used by 15.4% of women (46 of 298), more commonly in ART–naïve women than in those on cART (Table 2). An oral contraceptive was used by 32 women (6.9%); 13 (2.8%) used an oral contraceptive with a relatively high dose of oestrogen (i.e. ≥ 30 μg). More than half of the women (19 of 32) were using a hormonal contraceptive with potential interactions with their cART regimen (low–dose oral pill and NVP, EFV or boosted PI). One–third of oral contraceptive users (34.4%; 11 of 32) were on the progesterone–only pill. Half of all women on oral contraceptives had been using this method for > 2 years. Among these, 71.9% (23 of 32) reported never having forgotten to take the daily tablet, 18.8% admitted to having often missed one dose per month, and 9.3% admitted to having missed more than one dose per month. Two hundred and fifty–nine (57.4%) women reported having changed their type of contraceptive method over time. Similarly, 3.1% reported the use of dual contraception in the past compared with 10.7% at present (P < 0.001).

Women Not Using Contraceptives

Overall, 164 women (35.5%) reported no use of any type of contraception, although 65 (39.9%) were sexually active. Almost half of sexually active women (43.7%; 29 of 65) did not use any contraceptives and reported not wanting to conceive.

Unintended Pregnancies

Forty–eight of 440 women (10.9%) reported having experienced an unintended pregnancy; 39 of 48 were on contraception at that time. The most frequently reported contraceptive methods when the unintended pregnancy occurred were male condoms (47.3%) and oral contraception (42.1%) (Table 3). Half of all women currently using an oral contraceptive (50%; 16 of 32) had experienced an unintended pregnancy. Only one woman was on dual contraception when it occurred. Most women (86.7%; 39 of 48) who had experienced an unintended pregnancy were in a stable relationship, were white (62.5%; 30 of 48) and had a lower/middle education level (79.5%; 35 of 44). Although the exact ART regimen used at the time of the unintended pregnancy was unknown, half of women (23 of 48) were on ART at that time, mostly on a boosted PI regimen (Table 3). Most women (68.1%; 32 of 47) terminated the pregnancy and 56.3% (27 of 47) changed the contraceptive method after termination. Women with a lower education level were more likely to experience an unintended pregnancy (adjusted odds ratio 13.8; 95% CI 1.73–110.2; P = 0.013) than those with a higher education level. Women on ART had a lower risk of having an unintended pregnancy (adjusted odds ratio 0.06; 95% CI 0.03–0.15; P < 0.001) compared with women who were naïve to ART or not currently on ART.