Determinants of contraceptive choice among women with HIV

Objective: To examine factors associated with contraceptive choice among HIV-infected women. Design: Data for this cross-sectional analysis were derived from baseline visits of 435 participants in an ongoing prospective study of contraception among HIV-infected women in Russia. Participants enrolled in one of four groups: combined oral contraceptives (COCs) along with condoms, depot medroxyprogesterone acetate (DMPA) along with condoms, copper intrauterine device (IUD) along with condoms, or condoms alone. Methods: After contraceptive counseling and assessment of medical eligibility to use study methods, participants selected a method. Standardized interviews were used to collect demographic, reproductive and behavioral information. Results: Most women were eligible to use COCs (899%) and DMPA (94%); 87% of nonpostpartum women were eligible to use the IUD. The method chosen by most women was condoms alone (47%), followed by COCs along with condoms (29%), DMPA along with condoms (20%) and IUD along with condoms (4%). In multivariable analyses, independent predictors of choosing a method highly effective during typical use (COCs, DMPA, or IUD) along with condoms included having at least two births (prevalence ratio=1.4), postpartum enrolment (prevalence ratio=1.3), desiring (prevalence ratio=1.4), or uncertainty about desiring (prevalence ratio=1.3) a future pregnancy, prior oral contraceptive use (prevalence ratio = 1.3), recent injection drug use (prevalence ratio = 1.3) and never (prevalence ratio = 2.3) or sometimes (prevalence ratio = 1.9) using condoms in the last year. Conclusion: Among HIV-infected women, several characteristics that may place women at greater risk for unintended pregnancy and its adverse consequences were associated with choice of highly effective contraceptive methods. These findings may aid in the development of interventions to increase use of effective contraception among HIV-infected women. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins